My radiology frienemies are apprehensive about US guided biopsies and nearly always successfully convince patients to forego an ultrasound guided biopsy on their breast, lymph node, thyroid, neck lump, etc. I believe they would give up that service altogether if they could pass it on to someone else. I have a very low level of interest in pursuing this. In training, I did dozens and dozens of needle aspirations of anything palpable, but never with the benefit of ultrasound guidance. I'm thinking it might add a decent service line as well as a revenue stream. Any of you out there perform ultrasound guided biopsies? Should I even consider pursing this? Do I need some additional training for interpretation of thyroid US? I dunno? I'm kinda just thinking aloud. Anyone have thoughts?
US guided aspiration?
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Yeah, I have been doing them for a few years. I enjoy doing them, plus it gives our practice something unique that our competitors don't offer. Some will say that it is not time efficient for pathologists, but I would counter that at the very least it allows you to directly market a service that allows you to differentiate yourself. Learning to do them is not inherently difficult. You must become familiar with basic sonographic findings and sometimes the hardest part is electing NOT to biopsy something. As you earn trust, your clinicians will think that you can hit anything and get an answer, but sometimes the better part of valor is to defer.
The CAP course is good, but you will still need to spend some time with someone who does them to get a feel for how to select the lesion and basic practical issues. You can purchase an ultrasound phantom pretty affordably and practice once you have an ultrasound machine. One word of caution, though. Don't cheap out on the ultrasound unit. The range of resolution you can achieve is pretty significant.
If Rads is unwilling to do them, you already have a pretty good referral base. Reimbursement is decent, mainly because you can stack so many codes for one procedure (legitimately).
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Ive done it, in fact I was forced into for a short period of time a practice location that did ONLY that.
My thoughts are: if another specialty is willing to hand off a service line, you can pretty much guarantee the reimbursement vs. time sink equation is total garbage. No specialty gives up anything they actually make $ from.
I havent looked at the reimbursement on this line in a very long time and even back then it was crap, perhaps now super crap? I would map out all the CPT codes and see what average volumes might net you in terms of daily AR.
Picking up a service line in healthcare just because no one is doing it in your community is ABSOLUTELY not a convincing reason to do it. In fact, for me it is a huge red flag.
My thoughts are: if another specialty is willing to hand off a service line, you can pretty much guarantee the reimbursement vs. time sink equation is total garbage. No specialty gives up anything they actually make $ from.
I havent looked at the reimbursement on this line in a very long time and even back then it was crap, perhaps now super crap? I would map out all the CPT codes and see what average volumes might net you in terms of daily AR.
Picking up a service line in healthcare just because no one is doing it in your community is ABSOLUTELY not a convincing reason to do it. In fact, for me it is a huge red flag.
BamaAlum - I certainly understand the 88173 (1.39 rvu) and 88172 (0.69 rvu), which would legitimately be coded on every FNA. It looks like additional codes would include 10021 (1.27 rvu) and 78942 (0.67 rvu). So if my math is correct, I would get reimbursed slightly less on the actual performance of the aspiration (1.94) versus the interpretation (2.08 rvu). There is certainly more risk when performing the aspiration versus just interpreting it. If those are the only applicable CPT codes, then I'm not sure the risk:reward would be on my side, considering I'm only losing out on 1.94 rvu (which is like $100 or something). I was thinking the RVUs would be twice as much for the performance of the FNA. Am I missing anything?
Several other things to consider:
1. If the Rads docs avoid and disccourage doing FNAs then by doing them you would be generating the 88172s and 88173s that you wouldn’t normally get.
2. I perform my FNAs in a FNA clinic setting so I also bill E&M codes for history and physical (usually 99202). The US code (76942) used to be much higher but was cut a few years ago. You will use 10022 for image guided FNA. Of course 88305 if you make a cell block. Usually my codes look like this: 99202, 76942, 10022, 88172, 88173, 88305. Of course multiple lesions multiply 88172, 88173, 10022, and 88305.
3. As you become known as the “FNA dude” you will get referrals from docs you have never heard of simply by word of mouth. I have done zero marketing, yet I still get FNA patients from docs I have never met. One way I facilitate this is I have the patient list their PCP and any other doc they would like to receive a copy of the report. Don’t assume the pool of FNAs that the Rads guys are turning down will be the same as yours if you open a clinic. You will get more simply because you promote FNA and enjoy doing them.
4. Don’t underestimate the value of the patients themselves. I treat them well and explain everything in detail.
I also give them a preliminary result if the clinician is okay with it. Many of the patients will go back and tell the referring doc what a great experience it was. This becomes the best marketing you could ask for.
5. Bottom line is that US FNA can be a good revenue stream. Granted you aren’t gonna to make as much as you would if you landed an outpatient surgery center with huge GI volume, but how many of those are out there for the taking. With all of the codes you can easily average $700+ per patient. If you got to the point where you dedicated one day per week and saw 8 patients, that is >5K with very little overhead. Not too shabby in my opinion.
Reimbursement is the same as non US guided biopsies. You expose yourself to litigation, and the amount of time it takes to do the procedure etc. may not be worth it.... most of the people that pioneered pathologists doing FNas are in academic settings. Those in private settings compete with imaging centers. It is unlikely that this field will ever grow although it had potential because the leadership from CAP and ASCP is junk, unfocused, and waste of time.
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1. Reimbursement is not the same as non-image guided FNA. While it may not be significantly more, there is an added code for lesion localization.
2. "Those in private settings compete with imaging centers"- This is entirely location specific. In my area, the radiologists are ambivalent about doing US FNA. Plus, we have the added advantage of immediate assessment that they don't have. Turf wars over FNA are not usually that prevalent.
3. "Most of the people that pioneered pathologist doing FNAs are in academic settings."- I also disagree with this. I know of several large private FNA clinics. Sure there are some in academic settings, but the ones that I know of that do significant volume are private.
Again, this is not the equivalent of landing a surgery center, etc., but it can be a decent new and unique revenue stream. If you have a choice between a new GI contract and an FNA clinic by all means choose the GI contract. Is it time consuming? Somewhat, but you can schedule it to fit into a reasonable workflow. Most lesions are easy to reach, some are occasionally challenging. In my experience it gives our practice something unique to market that other competing groups do not have.
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Here in my neck of the woods, the main competition is ENT offices that have pretty much taken over the head and neck FNA bidness. Without that high volume work, there doesn't seem to be much demand.
