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Uncaptured Revenue in Plastic Surgery Training Programs - An Interim Analysis
Vickram J. Tandon, B.A., Brian C. Drolet, MD, Kamaris M. Loor, BS, Rachel Sargent, BA, Paul Y. Liu, MD.
Brown University, Providence, RI, USA.

Purpose: To evaluate potential revenue from services provided by plastic surgery (PRS) residents at a Level 1 trauma center.
Methods: All consults to the PRS service from January and February 2014 were coded using AMA Common Procedural Terminology (CPT) and Encounter and Management (E&M) codes. Billing codes were converted to work relative value units (wRVUs) and charges (dollars) were calculated using the standard Medicare conversion rate.
Results: A total of 349 consults were reviewed; 78.2% (N=273) of the patients were seen and treated by a PRS resident, under appropriate ‘indirect’ supervision as defined by PRS RRC guidelines. All patients were also evaluated and signed off by an emergency medicine attending. Patients not seen (e.g., telephone encounter) or seen by a PRS attending were excluded from the analysis. From these consults, 998.04 wRVUs were generated from billable E&M codes. Additionally, 68.4% (N=187) of consults had at least a single associated procedure, with a total of 277 CPT codes representing 618.07 wRVUs. Total charges from these encounters converted to \,893.
Conclusions: These results suggest that more than 10,000 annual wRVUs could be generated from the PRS consultation service, which is nearly the national average for a full time academic plastic surgeon. Such data may justify a PRS hospitalist salary or more focused direct supervision of high frequency and high charge consults to increase efficiency of workflow and billing.


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