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

p.s. This is cross posted in the IM CC subforum. Sorry didn't realize there were two CC forums and this one seems to be more frequented. I haven't posted much at this website in the last... err... decade

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[CCM-MD]

The biggest issues I have encountered regarding POCUS billing are: #1 images need to be saved in PACS, #2 lack of time thanks to covid, #3 liability, and #4 most of us are employed and don’t see the collections. I do get productivity though, do you happen to know what the wRVUs for each of those? I believe they are pretty piss poor but I could be wrong.

 

[CCM-MD]

Just looked it up. Limited echo 93308 pays 0.53 wRVU. I get 2 for a level 3 follow up and 4.5 for 1h of critical care time. So uhh. F that.

 

[Siggy]

Just looked it up. Limited echo 93308 pays 0.53 wRVU. I get 2 for a level 3 follow up and 4.5 for 1h of critical care time. So uhh. F that.

Meh, ultrasound as an extension of the physical exam can count towards critical care time. If you're already billing a significant amount of time, you can easily use your US time to get a 99292.

 

[CCM-MD]

Meh, ultrasound as an extension of the physical exam can count towards critical care time. If you're already billing a significant amount of time, you can easily use your US time to get a 99292.

Agree. Though I rarely do 99292s, the number of patients I am seeing prevents me from spending that much time with a single patient.

 

[Siggy]

Agree. Though I rarely do 99292s, the number of patients I am seeing prevents me from spending that much time with a single patient.

I'm doing mostly nights and my favorite billing play is the pre-midnight new crashing patient...

Those are generally good for a CPR if they code, 99291x2 (pre and post midnight), a-line, CVC, intubation, and likely at least 1 99292. The real fun is when I walk in the next night and pick up a second 99292...

 

[CCM-MD]

I'm doing mostly nights and my favorite billing play is the pre-midnight new crashing patient...

Those are generally good for a CPR if they code, 99291x2 (pre and post midnight), a-line, CVC, intubation, and likely at least 1 99292. The real fun is when I walk in the next night and pick up a second 99292...

Nice. I am not that brave... I worry about audits.

 

[Hamhock]

The biggest issues I have encountered regarding POCUS billing are: #1 images need to be saved in PACS, #2 lack of time thanks to covid, #3 liability, and #4 most of us are employed and don’t see the collections. I do get productivity though, do you happen to know what the wRVUs for each of those? I believe they are pretty piss poor but I could be wrong.

Is anyone able to knowledgeably comment on #3 liability?

Also, is there a minimum number of views that must be saved in PACS?

What's the minimal documentation required?

HH

@MalibuPreMD

 

[Siggy]

Nice. I am not that brave... I worry about audits.

I think it depends on the patient, documented diagnosis, and follow up exams. If a GI bleed suddenly codes, ends up with a massive transfusion and on multiple pressors, it's easy to get some significant time. I think the big thing is proper documenting showing constant titration, reexams, discussing goals of care with the proxy, and coordinating with specialists as appropriate. I think the problem most people end up with is trying to bill 90 minutes of CCT with a 2 problem list assessment/plan.