Billing for ultrasound guided blocks

[Planktonmd]

This is a question for the guys in private practice:
Can you give me an idea about how you are billing for ultrasound guided blocks and what codes you are using?
I really need to demonstrate to our admin that Ultrasound is a good thing and I need to do that by numbers.
So, any help is appreciated.

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[Noyac]

We are doing the same thing. We are trying to get an ultrasound (well some of us are while others are happy). We are claiming increased billing but I am getting the impression that this in not necessarily the case.

I'm also interested in how well you guys are collecting for the ultrasound.

 

[xyzdoc]

76937 for ultrasound guidance of vascular access.

76942 for ultrasound guidance of nerve blocks.

Medicare pays a little more than $20 if you don't own the ultrasound machine. Private insurances vary, but more than Medicare, as we all know.

Ultrasound is the way to go for blocks and CVC, epidurals if you have to.

 

[joshmir]

Can you bill for US guidance in an ASC, or only in the hospital?

 

[periopdoc]

Forgive me for stepping in as a non-private practice (yet) guy, but I have looked into this somewhat over the last couple of years. I am on vacation so I don't have my codes in front of me, but I remember most of the basics of billing for ultrasound.

First print a picture every time and place it with the anesthesia record. It doesn't have to be a great picture, just something to use as proof that you used an ultrasound on that block/ vascular access procedure. Put a patient sticker on it. Some people advocate labeling what is visible in the picture. That is probably overkill, but might save you some headache in an audit.

For the block itself I use the 644** codes with a modifier 59. The 644** codes are for the block and 10 days of management. While they theoretically show that the block is a separate procedure from the operative anesthetic (even if the operative anesthetic is MAC), it doesn't hurt to throw on the modifier 59 to reinforce that the block is a distinct procedural service from the operative anesthetic.

You should then code for the ultrasound guidance and interpretation. The 769** codes that xyzdoc listed are correct. However, if the procedure is done in a hospital or ASC etc you should add a modifier 26 to the ultrasound procedure code. Reimbursement for ultrasound in this setting is assumed by payers to be bundled into the hospital fee and they can deny payment for the ultrasound portion on this basis. By adding a modifier 26, you are indicating that you are billing for the professional interpretation of the obtained ultrasound image, not for obtaining the image itself. If you were to use an ultrasound in your office for vascular access etc, you would not need to use the modifier 26.

So for an intrascalene catheter your coding might look something like this.

Diagnosis - 719.41 Severe post-operative right shoulder pain
Procedures - 64416 -59 placement of brachial plexus infusion catheter
76942 -26 Professional interpretation of ultrasound image for catheter placement.


Most of the ultrasound companies are highly motivated to teach proper billing to maximize your income and the likelihood that you will buy/use their ultrasound. Here is a link to GE's booklet on the subject.

reimbursement_anesthesiology_2.25.09.pdf

I bet that sonosite and phillips have a booklets like this too.

Hope that helps

- pod

disclaimer. At this point I only play around with this stuff and my knowledge is primarily theoretical. I welcome any criticism from the guys who are billing and dealing with insurance every day because I would like to learn as much as possible about billing.

 

[Planktonmd]

Thanks POD.
Great response.

 

[periopdoc]

A much better link

Sonosite's Reimbursement Guides Website - Categorized information on billing for ultrasound. Includes several short separate pdf files on general billing, billing in the ASC, billing in the ICU, and TEE billing in addition to billing for other specialties. Includes some links to carrier sites and medical societies.

I couldn't find any guidance from Phillips.

- pod

 

[beezar]

regional.ucsd.edu

click on "forms" then "regional anesthesia attending note". on the left hand side is a lot of the billing codes they use. i think you might need the -26 modifier for the ultrasound portion unless you want to charge for the facility fee (which puts less money in your pocket unless you own the facility i believe).

also on the same site there is an article on billing for regional anesthesia that's good

 

[periopdoc]

regional.ucsd.edu

click on "forms" then "regional anesthesia attending note". on the left hand side is a lot of the billing codes they use. i think you might need the -26 modifier for the ultrasound portion unless you want to charge for the facility fee (which puts less money in your pocket unless you own the facility i believe).

👍👍👍

Yes you need the modifier 26 to bill interpretation of the ultrasound image as a professional fee if you are in a hospital or asc. Otherwise you get nothing for using the ultrasound to do the block.

My only problem with the form is that there is that there is no way to appropriately code when the block is the primary anesthetic modality. The 644** codes were introduced to indicate that the block is a separate procedure from the primary anesthetic, but this form appears to use the 644** to code both for blocks that are the primary anesthetic technique and those that are separately done for postoperative management. There should be a space to include modifier 59 to definitively identify the block as a separate procedure from the primary anesthetic technique.

- pod

 

[beezar]

:
My only problem with the form is that there is that there is no way to appropriately code when the block is the primary anesthetic modality. The 644** codes were introduced to indicate that the block is a separate procedure from the primary anesthetic, but this form appears to use the 644** to code both for blocks that are the primary anesthetic technique and those that are separately done for postoperative management. There should be a space to include modifier 59 to definitively identify the block as a separate procedure from the primary anesthetic technique.

- pod

You would code the primary anesthetic technique as a MAC case and the block as a separate procedure. This works because you would then bill the block for postop pain control rather than the primary technique. Payment for follow-up for blocks with catheters has recently changed as well. It has become unbundled and is no longer a global fee (hence the initial reimbursement will be less). But you can probably bill for each postop visit if you submit your postop visit notes to billing.