POCUS Reimbursement

[MalibuPreMD]

I'll be starting a surgical critical care fellowship in a year and change, currently doing an elective through our ED learning POCUS.

I was looking up reimbursement for critical care pocus and it seems really good:

CPT Code Examination Reimbursement—Global (2019 Q1 Medicare) Modifier 26 Modifier TC
76604 Chest ultrasound $107.11 $31.17 $75.90
93306 Complete echocardiogram with M mode, spectral, color Doppler $247.13 $83.16 $163.97
93307 Transthoracic echocardiogram without spectral or color $168.33 $51.17 $117.16
93308 Transthoracic echocardiogram, follow-up or limited study $118.62 $29.25 $89.37
93312 Transesophageal echocardiogram $292.84 $124.53 $168.31
76700 Abdominal, complete $145.87 $46.51 $99.35
76705 Abdominal, limited $109.05 $33.58 $75.47
76770 Retroperitoneal, complete $135.43 $42.59 $92.84
76775 Retroperitoneal, limited $69.59 $3320 $36.38
93970 Extremities venous, bilateral $238.30 $40.46 $197.84
93971 Extremities venous, unilateral $147.56 $26.49 $121.07

Modifer 26 is the professional component that a provider bills for (so global and technical component TC would not be the reimbursement)

So if a CC doc performs an exam in a patient intubated and on a pressor the following would be indicated:
- Chest (pulm)ultrasound - $30
- Limited ECHO - $50
- Abdominal limited - $30
- Retroperitoneal limited - $30
- DVT survey bilateral - $40

So a RUSH exam (~10 minutes + 4 minutes documentation) would net about $180. Complete this exam on 4-5 patients in a unit per shift: ~$700 for ~1 hour of work

Seems to make sense economically. Is anybody doing this in practice? Are these numbers reasonable?

Thanks

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[chessknt]

I'll be starting a surgical critical care fellowship in a year and change, currently doing an elective through our ED learning POCUS.

I was looking up reimbursement for critical care pocus and it seems really good:

CPT Code Examination Reimbursement—Global (2019 Q1 Medicare) Modifier 26 Modifier TC
76604 Chest ultrasound $107.11 $31.17 $75.90
93306 Complete echocardiogram with M mode, spectral, color Doppler $247.13 $83.16 $163.97
93307 Transthoracic echocardiogram without spectral or color $168.33 $51.17 $117.16
93308 Transthoracic echocardiogram, follow-up or limited study $118.62 $29.25 $89.37
93312 Transesophageal echocardiogram $292.84 $124.53 $168.31
76700 Abdominal, complete $145.87 $46.51 $99.35
76705 Abdominal, limited $109.05 $33.58 $75.47
76770 Retroperitoneal, complete $135.43 $42.59 $92.84
76775 Retroperitoneal, limited $69.59 $3320 $36.38
93970 Extremities venous, bilateral $238.30 $40.46 $197.84
93971 Extremities venous, unilateral $147.56 $26.49 $121.07

Modifer 26 is the professional component that a provider bills for (so global and technical component TC would not be the reimbursement)

So if a CC doc performs an exam in a patient intubated and on a pressor the following would be indicated:
- Chest (pulm)ultrasound - $30
- Limited ECHO - $50
- Abdominal limited - $30
- Retroperitoneal limited - $30
- DVT survey bilateral - $40

So a RUSH exam (~10 minutes + 4 minutes documentation) would net about $180. Complete this exam on 4-5 patients in a unit per shift: ~$700 for ~1 hour of work

Seems to make sense economically. Is anybody doing this in practice? Are these numbers reasonable?

Thanks

You think every intubated patient on a pressor needs a abdominal/RP/DVT ultrasound eh? They must be deemed medically necessary if you are billing so if you think you can just bag an abdominal ultrasound or 7 every day with serial exams you can bet you will eventually get audited for fraud.

If the stars align and somehow you have equipment good enough to take images and upload them to a server for storage, credentialing by a hospital to allow this, no pushback from radiology/cardiology for taking their revenue source, and the patience/time to somehow do all of these ultrasounds and enough confidence that your images and interpretation are perfect enough to withstand scrutiny in court (eg you wont miss minute findings that don't matter in a critical care setting but would in an outpatient setting) then yes you can bill for these. I can tell you in the many hospitals I have worked in I have not seen anyone bill for ultrasound or echo outside or rads/cardiology.

Billing something and getting someone to pay you for it are different things. CMS reduces charges in the same family when done on the same day by 25%. You cant bill critical care time if you are billing for images taken separately. Private payers might reject your claim entirely if you are including CC time or if you get a formal ultrasound the same day etc.

 

[NewYorkDoctors]

I am a pulmonologist and I bill for lung ultrasounds on all of my pulmonary consults (when warranted based on clinical situation ) on the non ICU setting in the hospital and office and get paid for it . No one else really bills for lung US (ie radiology )

most intensivist just increase ccm time spent if a thorough us exam were done

 

[ILikeMilk]

I am a pulmonologist and I bill for lung ultrasounds on all of my pulmonary consults (when warranted based on clinical situation ) on the non ICU setting in the hospital and office and get paid for it . No one else really bills for lung US (ie radiology )

most intensivist just increase ccm time spent if a thorough us exam were done

Do you have a pocket ultrasound? Seems like a hassle bringing an ultrasound up and down elevators