25 Interesting Statistics About Gastroenterology in Surgery Centers

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Here are 25 interesting statistics about gastroenterology and GI practices in surgery centers.

1. Gastroenterology was the most common specialty of single-specialty surgery centers in 2008, representing 28 percent of all ASCs.

2. GI practices in multi-specialty centers performed the highest number of procedures annually with an average of 3,710. In single-specialty centers, this number was higher, with an average of 5,379 cases annually.

3. More than one-third of multi-specialty surgery centers offer GI services, which is up 26 percentage points from 2000. It is the third highest at 37 percent, behind plastics and ophthalmology.

4. Gastroenterology represents the highest volume of total procedures in ASCs at 42 percent. Ophthalmology is second at 16 percent.

5. The average net revenue per case for gastroenterology is $780, with the highest average revenue in the Southwest ($869/case) and the lowest in the Southeast ($616/case).

6. The average net revenue per case changes with the number of operating room in a center. The average net revenue per case by number of operating rooms is as follows:

  • 1-2 ORs: $630
  • 3-4 ORs:  $740
  • More than 4 ORs: $798


7. The average net revenue per case changes with the number of cases that a center performs in a year. The average net revenue per case by number of cases is as follows:

  • Less than 3,000: $790
  • 3,000-5,999: $835
  • More than 5,999: $758


8. The average net revenue per case changes with the total net revenue of the surgery center. The average net revenue per case by total net revenue of the surgery center is as follows:

  • Less than $4.5 million: $683
  • $4.5-$7 million: $724
  • More than $7 million: $870


9. GI procedures hold the highest percent of the total case mix in the Midwest (34 percent) and the lowest in the Southwest (24 percent).

Medicare charges and payments
Here is the average 2007 Medicare sub charge (submitted charges divided by allowed services), average allow charge (Medicare-allowed charges divided by allowed services, including co-pays and deductibles paid by patient), and average payment (Medicare payments divided by allowed services, not including co-pays and deductibles paid by patient) for common upper- and lower-GI procedures commonly performed in ASCs.

Upper-GI procedures
10. Upper stomach-intestine scope, simple (CPT 43234)

  • average sub charge: $817
  • average allow charge $303
  • average payment: $237

11. Upper stomach-intestine scope for diagnosis (CPT 43235)

  • average sub charge: $1,064
  • average allow charge $318
  • average payment: $249

12. Stomach-intestine scope, inject intestine wall (CPT 43236)

  • average sub charge: $1,218
  • average allow charge $343
  • average payment: $271

13. Upper stomach-intestine scope for biopsy (CPT 43239)

  • average sub charge: $1,406
  • average allow charge $424
  • average payment: $334

14. Stomach-intestine scope ultrasound guided biopsy (CPT 43242)

  • average sub charge: $1,959
  • average allow charge $443
  • average payment: $352

15. Stomach-intestine scope for foreign body removal (CPT 43247)

  • average sub charge: $1,405
  • average allow charge $421
  • average payment: $331

16. Stomach-intestine scope with ultrasound exam (CPT 43259)

  • average sub charge: $2,018
  • average allow charge $508
  • average payment: $402

17. Scope of upper small intestine (CPT 44360)

  • average sub charge: $1,468
  • average allow charge $433
  • average payment: $343

18. Scope of upper small intestine with biopsy (CPT 44361)

  • average sub charge: $1,409
  • average allow charge $414
  • average payment: $327

Lower GI-procedures
19. Scope of colon thru ostomy for diagnosis (CPT 44388)

  • average sub charge: $1,203
  • average allow charge $323
  • average payment: $253

20. Scope of colon with biopsy thru ostomy (CPT 44389)

  • average sub charge: $1,338
  • average allow charge $308
  • average payment: $240

21. Scope of sigmoid colon only with biopsy (CPT 45331)

  • average sub charge: $945
  • average allow charge $287
  • average payment: $225

22. Scope of colon for diagnosis (CPT 45378)

  • average sub charge: $1,403
  • average allow charge $442
  • average payment: $345

23. Scope of colon with biopsy (CPT 45380)

  • average sub charge: $1,463
  • average allow charge $407
  • average payment: $319

24. Cancer screen colon scope, high risk patient (HCPCS G0105)

  • average sub charge: $1,272
  • average allow charge $441
  • average payment: $339

25. Cancer screen colon scope, not high risk patient (HCPCS G0121)

  • average sub charge: $1,327
  • average allow charge $443
  • average payment: $340


Sources:
Items 1-4: SDI's 2008 Outpatient Surgery Center Market Report.
Items 5-9: VMG Health 2008 Intellimarker.
Items 10-25: CMS.
Note: CPT codes are copyrighted by the AMA.

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