Coding for ultrasound guidance

Question:

Can you do an article on coding ultrasound guided musculoskeletal procedures and point of care (POC) ultrasound coding and documentation requirements? POC ultrasound is quickly becoming more common in primary care due to easy to use and affordable systems.

Answer:

I put this question to a colleague. This question came up with one of her hospital clients. Here is her answer.

Thoughts on ultrasound for guidance, for “quick look” point of care and for ultrasounds in full.

• Ultrasound guidance for things like fine needle aspirations or in ortho for injections or tenotomy are commonly performed and billed by non-radiologists and commonly have payer policies governing usage and coverage
• Ultrasound for “quick looks” are often non-billable because there isn’t a code that describes that service or they are not documented completely to meet coding guidelines, but that can be remedied if there is physician cooperation and clinic oversight
• Ultrasounds in full – i.e. abdominal, OB, etc. all have AMA coding guidelines and ACR guidelines and often have payer policies for coverage

There is a movement to start doing more ultrasounds in primary care and gynecology and more. The concerns we had for our client were two-fold. One is that they provide the same tests in the radiology department and those tests are performed by radiologists who follow ACR guidelines for their reports and format and they follow the clinical guidelines written by the ACR. They didn’t want to provide the same test by different providers that might be of different quality. The hospital decided that if these tests were done in a clinic/practice setting, they would need to follow the same guidelines. The second concern is that Medicare and some commercials have quality requirements for the training of personnel, testing and maintenance of equipment, cleanliness of equipment and that entailed management to make sure someone was overseeing the “program” and could ensure and manage those requirements.

The last onus of performing ultrasounds is the maintaining of records, not only the report but the digital storage. One client ran into a problem with a clinic that had the images stored on the machine and then replaced the machine with no plan to keep the stored data. In a facility, that process is all under the management of the diagnostic imaging department who fully understands and manages that process and has purchased a system for storage and retrieval of all records. So, if a patient has a test at the radiology department and requests a record, it is a single process. If the same patient had an ultrasound at a clinic, that might not be as easy to retrieve and the report might look entirely different.

Interestingly, the vendors are aware of some of these concerns and are somewhat cautious in their vendor guides for coding and billing. In the last couple of years the Academy of Family Practice has published a guide for clinics wanting to start doing their own ultrasound testing. It’s a bit of a heavy lift.

So, my thoughts are that this question has two lanes. There is ultrasound for musculoskeletal guidance and “quick looks” that may not be billable and another for performing more “real” ultrasounds.

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