Ultrasound machine

[pmrmd]

It’s a new year so we need a new thread on ultrasound machines. My Terason is on borrowed time. The picture is horrible and the iMac base is malfunctioning most days. Who recommends what machine? Thanks.

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[Gnarvin]

I also would be interested on everyone's opinion. In residency we used Sonosite SII and that was by far the best ultrasound I have used for nerve blocks. In fellowship we used a GE or Philips I think but I didn't like it as much as the SII. However, in private practice price of course is coming into play. What would be the best bang for the buck out there now that could come close to the SII image quality and features? I know Mindray makes what looks to be an SII ripoff that I assume is quite a bit cheaper than the Sonosite.

 

[Orin]

I might go to a WAPMU meeting and see some different ultrasounds up close. They generally also do some good teaching, but it's a great time to see the fanciest ultrasounds.

 

[Crybaby]

Just did the online demo of butterfly IQ- for the price it kicks the butt out of what I have been borrowing (old mindray) and a very old sonosite. The msk pictures they were showing me live were much better than on their website library.
I would love the edge II, but can't justify the price in my current situation
I have demo of vscan next week and am excited to see what it has to offer.

 

[callmeanesthesia]

Just did the online demo of butterfly IQ- for the price it kicks the butt out of what I have been borrowing (old mindray) and a very old sonosite. The msk pictures they were showing me live were much better than on their website library.
I would love the edge II, but can't justify the price in my current situation
I have demo of vscan next week and am excited to see what it has to offer.

Is the Vscan a live demo or online? I did the Butterfly demo and was impressed with the images, but am leaning toward the Vscan due to very positive reviews, no cable, and no ongoing fees.

 

[Crybaby]

Is the Vscan a live demo or online? I did the Butterfly demo and was impressed with the images, but am leaning toward the Vscan due to very positive reviews, no cable, and no ongoing fees.

They mail you one for 3 days and while you have it they schedule a 30min zoom meeting. I am excited to give it a try.

I like the idea of wireless but worry about the bluetooth drag

 

[nvrsumr]

I just got us code denial for lateral epicondylitis from bcbs. Biller fought it and we lost appeal.

outside of a heavy regen Med practice I would be hard pressed to justifying paying for more than the butterfly us these days.

 

[bedrock]

I just got us code denial for lateral epicondylitis from bcbs. Biller fought it and we lost appeal.

outside of a heavy regen Med practice I would be hard pressed to justifying paying for more than the butterfly us these days.

You mean BCBS denied the ultrasound portion of the injection?

agree that buying a new US these days isn’t worth it unless you do a lot of Regen Med.

 

[Propofool123]

How good is the image quality on Butterfly when you’re doing a block? I worry that because the footprint is so thick that it would be hard to use it for nerve blocks in clinic. Anyone have experience?

 

[NJPAIN]

What a damn shame. Ultrasound is a wonderful imaging modality with so many advantages over x-ray. But if you want to use it you’re expected to spend 30k + on a unit and throw it in for free.

 

[nvrsumr]

Yes the US code was denied and tendon sheath code approved.

 

[RoloTomassi]

Any updates on Butterfly vs Vscan? Very interested in purchasing one of the two

 

[Crybaby]

Any updates on Butterfly vs Vscan? Very interested in purchasing one of the two

I am demo'ing vscan right now. Picture quality is better than I expected. Have not tried injection with yet, so have not visualized needle.

I plan on buying butterfly and "trialing" it for 2 weeks. Will let you know.

 

[Agast]

Bump

Considering getting this. Really like that it has a 2-in-1 probe. Any updated thoughts?

 

[callmeanesthesia]

Bump

Considering getting this. Really like that it has a 2-in-1 probe. Any updated thoughts?

My GE Vscan Air is arriving next Wednesday. I’ll let you know.

 

[Agast]

My GE Vscan Air is arriving next Wednesday. I’ll let you know.

Besides cost, were there any reasons you considered this over the Lumify?

I was ready to pull the trigger but I’m worried about probe longevity

 

[Crybaby]

I just bought the butterfly IQ- should get it this weekend

I liked my demo of the Vscan air a lot. I considered buying it, but wanted to see how butterfly compares and I am really curious about the biplane imaging and difference in tech

 

[callmeanesthesia]

Besides cost, were there any reasons you considered this over the Lumify?

I was ready to pull the trigger but I’m worried about probe longevity

Just cost. Vs the butterfly, I just liked the wireless. I worry about the probe connection to the device. Also kinda like the curvilinear probe option so maybe I can do ultrasound hip injections.

 

[callmeanesthesia]

Got the Vscan Air today. The iPad still hasn’t shipped yet but I’ve tried it with my phone.
Haven’t used it on a patient but scanned my heart, lungs, and a few nerves. Impressed by the quality for such a small unit. Not sure if it’s any better than the Butterfly, which is half the price, but there’s no yearly membership fee, and no wire to break. Got myself a Pelican case to hold it all. Will upload some images when I get some clinical ones and keep you posted.

 

[Ducttape]

ugh.... dont use a big bottle of US gel...

Ultrasound gel as a source of hospital outbreaks: Indian experience and literature review - PubMed

This report highlights the importance of early identification of an outbreak, prompt response of the ICU and infection control teams, sound environmental and epidemiological surveillance methods to identify the source and stringent infection control measures to control the outbreak. Contaminated...

pubmed.ncbi.nlm.nih.gov

Outbreak of Acinetobacter baumannii associated with extrinsic contamination of ultrasound gel in a tertiary centre burn unit - PubMed

Based on data from our epidemiologic, microbiologic, and observational studies, we believe that inadvertent extrinsic contamination of the gel dispenser occurred in the Ultrasound Department. Contaminated gel was then dispensed into multiuse vials of gel stored on the mobile carts. The outbreak...

pubmed.ncbi.nlm.nih.gov

Ultrasound echocardiographic gel contamination by Burkholderia cepacia in an Italian hospital - PubMed

Ultrasound echocardiographic gel contamination by Burkholderia cepacia in an Italian hospital

pubmed.ncbi.nlm.nih.gov

Prolonged postprocedural outbreak of Mycobacterium massiliense infections associated with ultrasound transmission gel - PubMed

Postprocedural infections by Mycobacterium abscessus complex are increasing worldwide, and the source and route of transmission are infrequently identified. Here the extension of a previous clustering of paediatric patients with surgical site infections due to a single strain of the subspecies...

pubmed.ncbi.nlm.nih.gov

 

[callmeanesthesia]

ugh.... dont use a big bottle of US gel...

Ultrasound gel as a source of hospital outbreaks: Indian experience and literature review - PubMed

This report highlights the importance of early identification of an outbreak, prompt response of the ICU and infection control teams, sound environmental and epidemiological surveillance methods to identify the source and stringent infection control measures to control the outbreak. Contaminated...

pubmed.ncbi.nlm.nih.gov

Outbreak of Acinetobacter baumannii associated with extrinsic contamination of ultrasound gel in a tertiary centre burn unit - PubMed

Based on data from our epidemiologic, microbiologic, and observational studies, we believe that inadvertent extrinsic contamination of the gel dispenser occurred in the Ultrasound Department. Contaminated gel was then dispensed into multiuse vials of gel stored on the mobile carts. The outbreak...

pubmed.ncbi.nlm.nih.gov

Ultrasound echocardiographic gel contamination by Burkholderia cepacia in an Italian hospital - PubMed

Ultrasound echocardiographic gel contamination by Burkholderia cepacia in an Italian hospital

pubmed.ncbi.nlm.nih.gov

Prolonged postprocedural outbreak of Mycobacterium massiliense infections associated with ultrasound transmission gel - PubMed

Postprocedural infections by Mycobacterium abscessus complex are increasing worldwide, and the source and route of transmission are infrequently identified. Here the extension of a previous clustering of paediatric patients with surgical site infections due to a single strain of the subspecies...

pubmed.ncbi.nlm.nih.gov

Those seem to be mostly central line associated. Still, do any of you have a good recommendation for sterile probe covers? Hard to sort through what they have on Henry Schein because the filtering on their search sucks, and all the sterile ones seem absurdly expensive.

 

[jonnylingo]

For BILLING -- It is my understanding that a pre and post injection image needs to be saved. Is that the case?
And WHERE are you storing images?

 

[callmeanesthesia]

One of my partner’s PAs grabbed me as I was coming in this morning and asked if I would take a look at a patient she was worried had a DVT. I told her about the ultrasound yesterday and she was very interested in potential uses for it. Told the patient I’m not a sonographer and he would need to have a real study performed regardless, but apparently his PCP had ordered it a few days before and he hadn’t been contacted to schedule yet. Started with the popliteal fossa, and sure enough, he had a DVT! Sent him to the ER and they did a formal study that confirmed it.


Also, here’s a parasternal long axis view of my heart.

 

[Ducttape]

currently, hard copy. have a box of them.
in the future, in PACS.

i keep image of the needle placed appropriately, and an image of the needle and the therapeutic agent injected

 

[Ducttape]

One of my partner’s PAs grabbed me as I was coming in this morning and asked if I would take a look at a patient she was worried had a DVT. I told her about the ultrasound yesterday and she was very interested in potential uses for it. Told the patient I’m not a sonographer and he would need to have a real study performed regardless, but apparently his PCP had ordered it a few days before and he hadn’t been contacted to schedule yet. Started with the popliteal fossa, and sure enough, he had a DVT! Sent him to the ER and they did a formal study that confirmed it.
View attachment 345091

Also, here’s a parasternal long axis view of my heart.
View attachment 345093

when i was last in ER, ER residents were taught how to do this study.

 

[Dr. Ice]

For BILLING -- It is my understanding that a pre and post injection image needs to be saved. Is that the case?
And WHERE are you storing images?

Ultrasound has become only really worth it for regen now. As part of an ortho group, I do a ton of ultrasound guided procedures and realize I’m not getting paid for use of the ultrasound. Have gotten to the point where I have my assistant book out baker’s cyst aspirations and glut med tenon injections and proximal hamstring tendons, unless they are my own patients. It’s a great diagnostic tool, but unfortunately have to balance finances with offering the service to patients

 

[spondy14]

Ultrasound has become only really worth it for regen now. As part of an ortho group, I do a ton of ultrasound guided procedures and realize I’m not getting paid for use of the ultrasound. Have gotten to the point where I have my assistant book out baker’s cyst aspirations and glut med tenon injections and proximal hamstring tendons, unless they are my own patients. It’s a great diagnostic tool, but unfortunately have to balance finances with offering the service to patients

Why are you not getting paid for the ultrasound? There is a small difference between the 20610 and 20611, but with high volume it certainly makes sense. Of course, you have to own the ultrasound machine to collect the technical competent that helps with that payment.

 

[Painologist]

Got the Vscan Air today. The iPad still hasn’t shipped yet but I’ve tried it with my phone.
Haven’t used it on a patient but scanned my heart, lungs, and a few nerves. Impressed by the quality for such a small unit. Not sure if it’s any better than the Butterfly, which is half the price, but there’s no yearly membership fee, and no wire to break. Got myself a Pelican case to hold it all. Will upload some images when I get some clinical ones and keep you posted.

How has the Vscan air treated you now that you're 6 months in? How is the needle visualization? Is it suitable for PNS? I'm highly considering ordering one.

I am demo'ing vscan right now. Picture quality is better than I expected. Have not tried injection with yet, so have not visualized needle.

I plan on buying butterfly and "trialing" it for 2 weeks. Will let you know.

How was the needle visualization?

 

[Welcome123]

I just got us code denial for lateral epicondylitis from bcbs. Biller fought it and we lost appeal.

outside of a heavy regen Med practice I would be hard pressed to justifying paying for more than the butterfly us these days.

I would appeal and bill for a diagnostic scan which should be reimbursed. You will get denied for the guidance by most commercial carriers as they will only pay for specific conditions-for example Aetna requires a failed blind injection for most joints first before they pay for guidance. At least you can get something for your efforts.
Ncci edits specifically disallow reimbursement for guidance on a diagnostic scan to the injection site but it doesn’t matter since most carriers will deny guidance

 

[oreosandsake]

bought a konica minolta Jan 2022 barely used it at all. joining another practice with asc and equipment already.

considering selling if anyone is interested. I have the cart, and triple foot switch pedal.

 

[Norepi]

Anyone have any success/experience with the Clarius?

Clarius | Portable Pocket Handheld Ultrasound Scanners

Manage your exams anywhere and improve patient outcomes with clear, real-time imaging that is easy to use, affordable, and ultra-portable. Awarded Frost &am ...

clarius.com

I was quoted ~$3k for their 4-13 mhz or 5-15 mhz linear probes. $595 for annual membership. For this price I could see working in a private practice for certain MSK injections. I think it makes sense for things like GTB, stellate, PNS etc. Are y'all finding difficulty with reimbursement with these portable devices?

 

[Welcome123]

Ultrasound has become only really worth it for regen now. As part of an ortho group, I do a ton of ultrasound guided procedures and realize I’m not getting paid for use of the ultrasound. Have gotten to the point where I have my assistant book out baker’s cyst aspirations and glut med tenon injections and proximal hamstring tendons, unless they are my own patients. It’s a great diagnostic tool, but unfortunately have to balance finances with offering the service to patients

You can bill a diagnostic scan first. (Document the depth of injection target/site of maximal tenderness with sonopalpation) and get reimbursed for the dx scan. I use a limted scan code. I still document a guided injection as well but I don’t bill the guidance code (since it does not pay with most carriers and if you do a diagnostic scan first ncci edits don’t allow for guidance billing)

 

[spondy14]

You can bill a diagnostic scan first. (Document the depth of injection target/site of maximal tenderness with sonopalpation) and get reimbursed for the dx scan. I use a limted scan code. I still document a guided injection as well but I don’t bill the guidance code (since it does not pay with most carriers and if you do a diagnostic scan first ncci edits don’t allow for guidance billing)

Billing a diagnostic code in this situation is not recommended. This is bundled into the injection code and you are not diagnosing anything.

 

[Welcome123]

Billing a diagnostic code in this situation is not recommended. This is bundled into the injection code and you are not diagnosing anything.

Not recommended by who?
Ultrasound can be used for diagnostic purposes as well as interventional planning. When you order an xray-is there always pathology?
ligament tears, calcific tendons, normal scan, etc,,
I am not sure, if you fully read the post

 

[spondy14]

Not recommended by who?
Ultrasound can be used for diagnostic purposes as well as interventional planning. When you order an xray-is there always pathology?
ligament tears, calcific tendons, normal scan, etc,,
I am not sure, if you fully read the post

Maybe you could clarify what you are billing or give some examples. I work with a large ortho group and for example:
When I get a referral for an
1. IA hip injection (20611)
2. Subacromial injection (20611)
3. Greater troch injection (20611)
4. Glenohumeral injection (20611)
5. AC injection (20606)
6. CMC injection (20604)

I am able to bill the appropriate US code listed.
If its a biceps tendon, Iliopsoas tendon, or deQuervains injxn I would use 76942 and 20550.

Not appropriate to bill 76881 or 76882 (diagnostic codes) for any of these. Im not diagnosing anything and I can't just add it because insurance will "cover" it. If fact, Medicare won't pay even if you bill for them together.
For example, If they send me a case of "eval rotator cuff" and inject if appropriate. I could code both, but both won't get paid.
If they send a patient like that its best to just send patient back and let them resend for SAC or IA injection.
Hope that helps

 

[Welcome123]

Maybe you could clarify what you are billing or give some examples. I work with a large ortho group and for example:
When I get a referral for an
1. IA hip injection (20611)
2. Subacromial injection (20611)
3. Greater troch injection (20611)
4. Glenohumeral injection (20611)
5. AC injection (20606)
6. CMC injection (20604)

I am able to bill the appropriate US code listed.
If its a biceps tendon, Iliopsoas tendon, or deQuervains injxn I would use 76942 and 20550.

Not appropriate to bill 76881 or 76882 (diagnostic codes) for any of these. Im not diagnosing anything and I can't just add it because insurance will "cover" it. If fact, Medicare won't pay even if you bill for them together.
For example, If they send me a case of "eval rotator cuff" and inject if appropriate. I could code both, but both won't get paid.
If they send a patient like that its best to just send patient back and let them resend for SAC or IA injection.
Hope that helps

For clarity
1. Ncci edits will not allow for guidance codes when a diagnostic scan is done on the same visit of the region to be injected.
2. Reimbursement for ultrasound guidance is not universal by all carriers-many will say it is unproven and not covered
My recommendation was to bill a diagnostic scan in that setting as appropriate or in the instance where guidance is not covered
Some of the carriers will not allow for guided injections. I believe you when you say you are billing, I am doubtful that you are getting reimbursed universally by all carriers. For example-Aetna stipulates in their clinical policy bulletin-a failed blind injection is required first-or sometimes they just don’t such as

• Acromioclavicular joint
• Subacromial bursitis injection
• See below link to view the other disallowed sites

Ultrasound Guidance – Selected Indications - Medical Clinical Policy Bulletins | Aetna

www.aetna.com

Not all carriers will acknowledge the 76942 code
Of the ones that do, it does not make sense to bill for diagnostic scans.
For the ones that don’t, well that is your decision what you want to do

 

[bedrock]

Bummer the codes don’t reliably pay ultrasound any longer.


I would just do all of those joint injection procedures you listed under x ray , quicker, and you get paid for the fluoro code.

Only really need US for tendon/nerve injections.

 

[Welcome123]

Bummer the codes don’t reliably pay ultrasound any longer.


I would just do all of those joint injection procedures you listed under x ray , quicker, and you get paid for the fluoro code.

Only really need US for tendon/nerve injections.

Unfortunately, fluoro is not always covered.
Aetna considers fluoroscopic guidance for viscosupplementation experimental and investigational. There is a tendency for carriers to follow each other when it comes to these matters.
I hate to be the harbinger of bad news.

 

[bedrock]

Unfortunately, fluoro is not always covered.
Aetna considers fluoroscopic guidance for viscosupplementation experimental and investigational. There is a tendency for carriers to follow each other when it comes to these matters.
I hate to be the harbinger of bad news.

Maybe not Aetna but joint fluoro is covered by Medicare, BCBS, WC, etc so more than 75% of most patients you treat in private practice.

 

[Welcome123]

Maybe not Aetna but fluoro is covered by Medicare, BCBS, WC, so more than 75% of most peoples practices.

3/4 full or 1/4 empty 🤷‍♂️