Disclaimer: All information on this page was created by someone who is not employed by any hospital coding or billing company and is not a professional and/or official listing of information on hospital or ED charges. This page describes an estimation, approximation, and reviews the publicly known CPT codes and LCD info for each limited ultrasound procedure as found publicly online and in the CPT manual. It is not meant to be a guideline, an actual or true charge for insurance companies or hospitals, or describe a specific hospital’s charges/billing practices. View at your interest, but please understand that each hospital, insurance provider, state within the USA will have variations in charges/reimbursement/coverage.
Summary for presumed changes for 2014 here.
This page is an approximate description of the wRVUs, and hospital and professional charges, for limited ultrasound procedure billing. It also includes ED Level Codes and wRVUs, CPT codes and a description of the modifiers that are needed for limited ultrasound, as well as the known requirements for procedural guidance in order to bill for ultrasound. Thanks to ACEP US Section for already providing a great template to start from, and to the other US Directors who currently bill for limited US for their input on the information.
The hospital bills for the technical fee (-TC). The physician performing and interpreting the ultrasound procedure bills for the professional fee (-26). The total charged to the patient is both.
In order to bill for focused ultrasound procedures, the following information is needed in the chart: (most of the information can be described automatically within a pre-written procedure note/template or a smartphrase created for your EMR within the procedure section (go here to view sample EPIC smartphrases). An order must be placed and this is done either separately or, with some EMRs, placing the smartphrase within the procedure tab generates an order. This needs to be done on the same date of service).
1. Scan performed and interpreted (with written report in medical record), and signed by qualified/responsible (privileged) physician
2. Medical necessity must be valid, and documented
3. Document findings, interpretation, scope of study (“limited”)
4. Describe the organs/regions of interest
5. The report must be a separately identifiable written report although it does not have to be on a separate piece of paper (can be placed as a procedure note)
6. Must have permanently recorded/archived images in order to bill
7. Record and Images are Retrievable (need MRN)
8. Order must be created for Limited ED Ultrasound
9. Quality of scan in keeping with national guidelines, not requiring follow up study to confirm results
– – A Radiology Ultrasound for the same purpose at the same time of Limited Ultrasound to confirm results will prevent scan from being billed
– A repeat US done by a physician at a different time for different reason (new abdominal pain, hemodynamic status change, etc) can be billed.
In summary, what is needed when practicing in an academic emergency department:
(1) Attending privileged in US,
(2) Images recorded,
(3) MRN placed on images
(4) US procedure order/note/attestation by Attending for a medically indicated scan
What is also on the below excel file is a second sheet called “privilege form”. The sample privilege form is exactly that – a sample. It is thought to be a recommendation written by me based on ACEP guidelines. It reviews both initial and renewal criteria for hospital privileging in bedside goal-directed, focused ultrasound procedures.