RISK FACTORS BY SPECIALTY AND SURGERY CLASS

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For rarely-billed Medicare procedures, we did not apply the 5 percent threshold for inclusion of services or specialties as utilized in previous MP RVU updates. Rather, we are proposing to use the risk factor of the dominant specialty by services for each procedure for which the number of allowed services is less than 100. This approach reflects the risk factors of the specialty that most frequently furnishes these low volume  procedures.
(3) Calculate a risk factor for each specialty. Differences among specialties in malpractice premiums are a direct
reflection of the malpractice risk associated with the services furnished by a given specialty. The relative differences in national average premiums between various specialties can be expressed as a specialty risk factor. These risk factors are an index calculated by dividing the national average premium for each specialty by
the national average premium for the specialty with the lowest average premium, allergy/immunology. Table 7
shows the risk factors by specialty and surgery class.


TABLE 7—RISK FACTORS BY SPECIALTY AND SURGERY CLASS

 Medicare code    Medicare name    Non-surgical RF    Minor-surgical RF    Major-surgical RF  
1  General Practice …………………………………………………………………………    1.50    2.26    3.56  
2  General Surgery ………………………………………………………………………….    5.87    5.87    5.87  
3  Allergy Immunology ……………………………………………………………………..    1.00    1.00    1.00  
4  Otolaryngology ……………………………………………………………………………    1.44    2.37    3.55  
5  Anesthesiology ……………………………………………………………………………    2.22    2.22    2.22  
6  Cardiology ………………………………………………………………………………….    1.87    2.65    6.09  
7  Dermatology ……………………………………………………………………………….    1.14    2.06    3.96  
8  Family Practice …………………………………………………………………………..    1.57    2.23    3.79  
10  Gastroenterology …………………………………………………………………………    2.03    2.48    4.09  
11  Internal Medicine …………………………………………………………………………    1.72    2.52    2.52  
13  Neurology …………………………………………………………………………………..    2.20    2.90    10.28  
14  Neurosurgery ……………………………………………………………………………..    9.94    9.94    9.94  
16  Obstetrics Gynecology …………………………………………………………………    1.67    2.37    4.64  
18  Ophthalmology ……………………………………………………………………………    1.07    1.68    1.90  
19  Oral Surgery ……………………………………………………………………………….    1.00    1.00    1.00  
20  Orthopedic Surgery ……………………………………………………………………..    5.46    5.46    5.46  
22  Pathology …………………………………………………………………………………..    1.74    2.26    2.26  
24  Plastic and Reconstructive Surgery ……………………………………………….    5.51    5.51    5.51  
25  Physical Medicine and Rehabilitation …………………………………………….    1.14    1.14    1.14  
26  Psychiatry …………………………………………………………………………………..    1.22    1.22    1.22  
28  Colorectal Surgery ………………………………………………………………………    3.99    3.99    3.99  
29  Pulmonary Disease ……………………………………………………………………..    2.08    2.08    2.08  
30  Diagnostic Radiology …………………………………………………………………..    2.62    2.62    2.62  
33  Thoracic Surgery …………………………………………………………………………    6.51    6.51    6.51  
34  Urology ………………………………………………………………………………………    2.64    2.64    2.64  
35  Chiropractic ………………………………………………………………………………..    1.00    1.00    1.00  
36  Nuclear Medicine ………………………………………………………………………..    1.55    1.55    1.55  
37  Pediatric Medicine ……………………………………………………………………….    1.49    2.41    2.41  
38  Geriatric Medicine ……………………………………………………………………….    1.43    2.23    4.22  
39  Nephrology …………………………………………………………………………………    1.61    2.27    4.17  
40  Hand Surgery ……………………………………………………………………………..    3.49    3.49    3.49  
44  Infectious Disease ……………………………………………………………………….    2.09    2.52    2.52  
46 Endocrinology  1.51    2.23    4.46  
48 Podiatry 1.98 1.98 1.98
62  Psychologist ……………………………………………………………………………….    1.00    1.00    1.00  
65  Physical Therapist ……………………………………………………………………….    1.00    1.00    1.00  
66  Rheumatology …………………………………………………………………………….    1.56    1.56    1.56  
67  Occupational Therapist ………………………………………………………………..    1.00    1.00    1.00  
68  Clinical Psychologist ……………………………………………………………………    1.00    1.00    1.00  
71  Registered Dietitian/Nutrition Professional ……………………………………..    1.54    1.54    1.54  
72  Pain Management ……………………………………………………………………….    2.21    2.21    2.21  
77  Vascular Surgery ………………………………………………………………………..    6.50    6.50    6.50  
78  Cardiac Surgery ………………………………………………………………………….    6.89    6.89    6.89  
79  Addiction Medicine ………………………………………………………………………    1.00    1.00    1.00  
81  Critical Care (Intensivists) …………………………………………………………….    2.15    2.15    2.15  
82  Hematology ………………………………………………………………………………..    1.59    2.03    2.03  
83  Hematology/Oncology ………………………………………………………………….    1.72    1.72    1.72  
84  Preventive Medicine …………………………………………………………………….    1.16    1.16    1.16  
85  Maxillofacial Surgery ……………………………………………………………………    1.00    1.00    1.00  
86  Neuropsychiatry ………………………………………………………………………….    1.22    1.22    1.22  
90  Medical Oncology ……………………………………………………………………….    1.76    1.76    1.76  
91  Surgical Oncology ……………………………………………………………………….    5.87    5.87    5.87  
92  Radiation Oncology ……………………………………………………………………..    2.30    2.30    2.30  
93  Emergency Medicine …………………………………………………………………..    2.29    3.77    4.87  
94  Interventional Radiology ………………………………………………………………    2.62    2.62    2.62  
98  Gynecological/Oncology ………………………………………………………………    1.76    1.76    1.76  
99  Unknown Physician Specialty ……………………………………………………….    1.50    2.26    3.56  

1 Comment

  1. Anonymous
    Anonymous on July 1, 2011 at 9:32 pm

    can any one pls suggest me how to get a payment for jcodes if they got submitted with correct ndc codes