ultrasound in chronic pain

[painfree23]

If starting a new practice , typical private practice set up (would count towards my overhead) would you recommend renting an old ultrasound machine for a few abdominal pain (ilioinguinal) blocks, stellates, occipital rds, etc procedures? Hate to lose those patients to another provider who would do those just bc I don't have ultrasound

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[AKMD_1984]

If starting a new practice , typical private practice set up (would count towards my overhead) would you recommend renting an old ultrasound machine for a few abdominal pain (ilioinguinal) blocks, stellates, occipital rds, etc procedures? Hate to lose those patients to another provider who would do those just bc I don't have ultrasound

you can schedule all your U/S patients together and do them at a close by ASC or hospital...yes, its annoying, but atleast you can still provide service, and wont have to worry about owning a U.S unit..

 

[painfree23]

you can schedule all your U/S patients together and do them at a close by ASC or hospital...yes, its annoying, but atleast you can still provide service, and wont have to worry about owning an U.S unit...

That's a good idea, but if I have to schedule a hospital procedure , that'd probably take 2 hours out of my clinic time, for the pro fee of like $120 bucks , just wondering about if its worth spending 30g on an ultrasound machine that may last me a few years

 

[AKMD_1984]

That's a good idea, but if I have to schedule a hospital procedure , that'd probably take 2 hours out of my clinic time, for the pro fee of like $120 bucks , just wondering about if its worth spending 30g on an ultrasound machine that may last me a few years

Not sure what the reimbursment in clinic for an average US guided procedure is, but if its 200 dollars, then you would need to do 30, 000/ 20 = 1500 procedures just to break even...

that sounds like a lot/ not worth it.

 

[painfree23]

Not sure what the reimbursment in clinic for an average US guided procedure is, but if its 200 dollars, then you would need to do 30, 000/ 20 = 1500 procedures just to break even...

that sounds like a lot/ not worth it.

Well not the procedure alone, but u have to account for ur time running to the hospital to do the procedure while ur clinic is on hold (or you could be doing 3 ESIs in clinic) in that time, right?

 

[AKMD_1984]

Well not the procedure alone, but u have to account for ur time running to the hospital to do the procedure while ur clinic is on hold (or you could be doing 3 ESIs in clinic) in that time, right?

if you are not doing a lot of U/S guided blocks, then you can schedule all your U/S blocks once a month at an ASC and do it then.
you will get paid the professional fees and wont have any overhead...

 

[NJPAIN]

Great modality. But insurance has killed it. Cannot justify the cost. If I didn't already have a leased unit I wouldn't buy one. Damn shame.


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[Aether2000]

It is unlikely in a chronic pain practice, you would be doing enough US guided nerve blocks to financially justify purchasing an ultrasound. Joint, bursa, tendon, ligament and epidural injections are frequently not reimbursed using ultrasound. Diagnostic usage for MSK US is reimbursed but at a diminishing rate. I personally use US at least 2-5 times a day in my patients, but only occasionally receive reimbursement for its usage.

 

[nvrsumr]

I just fired my us machine back up as 77002 being "bundled" with peripheral nerve blocks per another thread.

I wouldnt buy a machine theses days. Went from 5 us injections a day 2 years ago to maybe 5/week now

 

[oreosandsake]

honest Q here: does writing off capital equipment make it worthwhile?

 

[clubdeac]

So just to make sure I understand, you can no longer bill for US for peripheral joint or tendon injections???

 

[cowboydoc]

honest Q here: does writing off capital equipment make it worthwhile?

You can spend a dollar and save ~40 cents in taxes (whatever your marginal rate is). Doesn't justify a purchase, but it softens the blow off the expense.

 

[cowboydoc]

So just to make sure I understand, you can no longer bill for US for peripheral joint or tendon injections???

Joint injections are bundled 20611 for large joints. 1.65 RVUs vs 0.79 RVUs for a 20610 (regular large joint injection)

For non-bundled injections, you can bill 76942 for U/S guidance for needle placement. Depending on documentation, 76882 can be added for limited diagnostic U/S. Regarding collections, YMMV, and I it doesn't seem you make much using U/S compared to the time it takes, not to mention the capital expense of purchasing the machine.

Practically, it's nice for some peripheral nerve injections. I do a lot of hip injections with it, as it saves my patients a lot of money, because I otherwise have to send them to our ASC to do under fluoro.

 

[bedrock]

Joint injections are bundled 20611 for large joints. 1.65 RVUs vs 0.79 RVUs for a 20610 (regular large joint injection)

For non-bundled injections, you can bill 76942 for U/S guidance for needle placement. Depending on documentation, 76882 can be added for limited diagnostic U/S. Regarding collections, YMMV, and I it doesn't seem you make much using U/S compared to the time it takes, not to mention the capital expense of purchasing the machine.

Practically, it's nice for some peripheral nerve injections. I do a lot of hip injections with it, as it saves my patients a lot of money, because I otherwise have to send them to our ASC to do under fluoro.

Agree with above. Joints are bundled. However, To be clear, you do still get paid for both nerve and tendon injections under ultrasound, correct?

 

[BobBarker]

But is it a .86 RVU difference betweeen the two codes. I think that is fair compensation for the added work of using the US. It comes out to just over $57 for me. If I could find an US for less than 10k that was good I think it would make business sense. I do at least 5 knees and a couple subachromials a week blind in the office.

 

[cowboydoc]

Agree with above. Joints are bundled. However, To be clear, you do still get paid for both nerve and tendon injections under ultrasound, correct?

Yes. Nerve/tendon code PLUS 76942.

 

[drpainfree]

Agree with above. Joints are bundled. However, To be clear, you do still get paid for both nerve and tendon injections under ultrasound, correct?

yes, but you have to be careful with ICD/CPT. Look for LCD for uncovered ICDs.