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US takes a hit
Started by sblau001
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Does this include fluoro also?
how much do the previous codes for small, med, large joints pay? (no US)
No. This does not include fluoro.
In Colorado:
20600 = 48.49
20605 = $50.64
20610 = $61.05
Adding US guidance is an additional $74.51,
So based on new codes, the decreased reimbursements come out to roughly $51 less for all procedures.
thanks for the information, I should look it up myself but haven't yet.
do you know what US guidance for other procedures is? is 76942 still around for tap or nerve block, tendonopathies, etc
do you know what US guidance for other procedures is? is 76942 still around for tap or nerve block, tendonopathies, etc
These new codes are for joint injections only, which means you can still bill 76942 with everything else. Funny how doing a thoracic trigger point injection with US guidance to prevent pneumothorax will now pay $44 more than a large joint injection.
I think with this trend the only way for use of US to remain financially viable is to purchase the cheapest US machines available. A friend of mine just purchased this one:
http://www.ebay.com/itm/Promotion-N...ty-/221442113363?ssPageName=ADME:L:OC:US:3160
Assuming you add a 3.5 MHz convex probe, it should still come out to around $2,000. There is another Chinese company on ebay making similar knock-offs with prices below 2k. Can't vouch for the quality or sturdiness of these units, but I think the days of spending anything over 15k for an US are over.
ASSIP link still shows
20610 $60 for 2015
77002 $64 for 2015
I didn't see the new code you reported
20611 $91 for 2015
Are we able to bill 20611 and 77002? If so then more $$
I think I misunderstood your post and it is specific for us. In that case can still use 20610 with 77002 which is a cut but better than US.
I appreciate the heads up on the coding just trying to figure out the specifics.
20610 $60 for 2015
77002 $64 for 2015
I didn't see the new code you reported
20611 $91 for 2015
Are we able to bill 20611 and 77002? If so then more $$
I think I misunderstood your post and it is specific for us. In that case can still use 20610 with 77002 which is a cut but better than US.
I appreciate the heads up on the coding just trying to figure out the specifics.
I don't see the actual 77002 reimbursement. I don't believe 7002-TC and 77002-26 are for joint injections
F**k it. The ortho guys can have it. I'll make more managing an 80 yr olds QD tramadol in the time slot.
Interpret your findings that was to US-how much does adding a limited extremity US pay? If you want I'll interpret them for you for a few bucks.
Which is exactly the way CMS wants it to be for physicians...
???
Freddy is a radiologist in a pain fellowship.
BTW, can anybody answer how much a diagnostic MSK ultrasound pays, that is performed in office?
My guess is very close to the current value of the guidance code, but I have no concrete data.
US examination codes were divided into 2 separate codes a few years back, 76881 for a complete exam, and 76882 for a limited exam. (Some say this was in response to every podiatrist and his brother taking a 10 second look at every patients' heel and diagnosing plantar fasciitis, then billing out a fortune.) In any case, 76881 pays $120, and 76882 pays $36. 76881 will pay $3 less in 2015, at $117. I'm not sure how much less 76882 will pay, but can't imagine it will be more than a few dollars less, assuming it doesn't stay the same. To bill 76881 though, you really have to do a complete exam with full documentation. You can't just write, "No supraspinatus tear." My shoulder exam reports are a page and half long, commenting on every aspect including dynamic tests for impingement and AC joint separation. For the limited exam, your reports can be much more basic. Mine are usually a paragraph or 2 long. For example, a recent one went something like this: "There was significant soft tissue swelling seen in the adductor musculature. A hyperechoic region within the adductor musculature septa was noted, with the greatest amount of soft tissue swelling surrounding this area. The hyperechoic region also displayed the most sensitivity to palpation. This area is highly suspicious for early heterotopic ossification and triple phase bone scan is recommended. No obvious muscle tears or masses noted."
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Very helpful. Thanks.
And that landed $36?? I think Gypsy palm readers get more and they get to pick your pocket too!
More like 25-30% of what it used to pay for guidance.
But, only a very cheap US machine would be worthwhile now, and only if you do a lot of blocks which truly require US, or you do a lot of cash pay PRP cases with US guidance.
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Fetal photos.
Brilliant!! I can include a family ultrasound portrait and perhaps ultrasound Christmas cards.
just what I said above. Lots of nerve blocks, lots of tendon injections with steroid or PRP.
actually, I've heard of those baby showers where mothers are paying for US techs to come out and show off the baby... not illegal yet... but it probably should be.
I think the machines have to be FDA approved in order to bill it out. I don't think that machine is despite the ambiguous disclaimer on the bottom of the page.
Not sure where you got your info from, but the new codes seem to be bundled for ALL joint injections, as listed in my original post.
20604, 20606, and 20611.
Small, medium, large- all bundled, yay!
The new kyphoplasty codes bundle in anesthesia and radiologic interpretation as well. Fun fun fun!
Small, medium, large- all bundled, yay!
The new kyphoplasty codes bundle in anesthesia and radiologic interpretation as well. Fun fun fun!
this was discussed at the AAPMR annual conference, they said since the major jt code was most utilized between all the injection this once was scrutinized with the review and they discussed only the cuts for the major. I am not sure why they would omit the others if its also bundled???
I don't know the final word on the joint codes, but there would be a little justice in keeping guidance separate for small joints, for which guidance is more necessary than a knee injection.
This is very sad.
Injection with ultrasound guidance takes a lot of practice, skill, and know-how. It may also add time to your injection. This should be considered.
In addition, it makes the injections safer (according to nerve block data) - and every study in pain and ortho journals that have looked at it have found that it - BY FAR - makes it more effective. Even in experienced hands, blind injections miss the spot a lot of the time.
To me, if you cut reimbursement, you are begging physicians to abondon the practice - which in essence will decrease the level of care. How could they not see this?
Policy should be made such that practice patterns improve care....very very sad, and poor decision by CMS.
Injection with ultrasound guidance takes a lot of practice, skill, and know-how. It may also add time to your injection. This should be considered.
In addition, it makes the injections safer (according to nerve block data) - and every study in pain and ortho journals that have looked at it have found that it - BY FAR - makes it more effective. Even in experienced hands, blind injections miss the spot a lot of the time.
To me, if you cut reimbursement, you are begging physicians to abondon the practice - which in essence will decrease the level of care. How could they not see this?
Policy should be made such that practice patterns improve care....very very sad, and poor decision by CMS.
I agree. I used to think image guidance for simple joint injections wasn't helpful, until I tried a few. I use Fluoro only because I was about to buy US until the cuts came last year, and abandoned just in time. But I noticed that when I started doing seemingly easy joints with fluoro, it became obvious to me that there were times I thought I was in with landmark technique, yet I look up at the screen and I'm clearly not. With today's growing population obesity, I think image guidance is becoming more needed with previously simple injections. So they killed US guidance. Fluoro will be next, but you're right, it's a shame. Because people are going to abandon a better technique for one less accurate and the quality of care will decrease. I'm sure it's happening in all other specialties too. It a sign of the times.
And no one profited ridiculously and tried to justify it. Every time I read an epidurogram report.....
Routine use is a waste of time and effort. I like when BCBS said if BMI is 40+ then US OK for fat knees. That makes sense. Literature supports 87% success in superolateral approach blind. Good enough for steroids and probably for Visco. Even though AAOS says Visco doesn't work.
Routine use is a waste of time and effort. I like when BCBS said if BMI is 40+ then US OK for fat knees. That makes sense. Literature supports 87% success in superolateral approach blind. Good enough for steroids and probably for Visco. Even though AAOS says Visco doesn't work.
I wouldn't say that 87% success rate is good enough for a blind injection. 98-99% percent maybe.
Remember that the patients who fail knee injections are often getting TKA, which has an 85% success rate, and those that fail TKA, often end up getting revision surgery or are just left with permanent knee pain. $75 for image guidance is more than reasonable to pay for any knee or shoulder injection, when you consider the risks, relative success, and cost of the surgical alternative.
I had a similar experience to what was described by EMD above. Once I started using fluoro for knees and shoulders, I noticed that 15-20% of the time when I thought I was in, I wasn't.
I say image guidance of some kind should be required for all joint injections. That way, all the half-assed blind injections by the orthopods wouldn't count as failure of conservative care, and patients wouldn't get unnecessary surgery.
Which is more expensive in the long run? It's not image guidance for joint injections.
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Sounds nice and all. But not in merica. Politics and practice patterns go against this. Utopian. But never going to happen.
Maybe so, but as a pain physician, you shouldn't side with insurance companies trying to restrict coverage for guidance codes to only fat patients, as you stated in your last post.
What about nerve blocks? Is US bundled?femoral, etc
You should never be in favor of reduced reimbursement. For anything. They've got enough help trying to tear us down without aiding the enemy.
I do not believe nerve blocks have been bundled. I also use US for thoracic TPI's to avoid pneumothorax and I do not believe that is bundled either. (It is also good practice to use M-mode following the procedure to make sure- and document definitively- that no pneumo occurred.)
Using ultrasound roughly gives you 30$
CY 2015 Facility and Non-Facility payment for arthrocentesis/joint injection
CPT
Code Descriptor Total Facility Payment* Total Non-FacilityPayment* CY 2015
20600 Arthrocentesis, aspiration and/or injection, small joint or bursa
(e.g., fingers, toes); without ultrasound guidance $36.52 $48.33
20604 with ultrasound guidance, with permanent recording and reporting $46.18 $72.32
20605
Arthrocentesis, aspiration and/or injection, intermediate joint or
bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or
ankle, olecranon bursa); without ultrasound guidance
$37.95 $50.48
20606 with ultrasound guidance, with permanent recording and reporting $61.58 $79.48
20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g.,
shoulder, hip, knee, subacromial bursa); without ultrasound guidance $47.26 $60.86
20611 with ultrasound guidance, with permanent recording and reporting $61.58 $91.29
CY 2015 Facility and Non-Facility payment for arthrocentesis/joint injection
CPT
Code Descriptor Total Facility Payment* Total Non-FacilityPayment* CY 2015
20600 Arthrocentesis, aspiration and/or injection, small joint or bursa
(e.g., fingers, toes); without ultrasound guidance $36.52 $48.33
20604 with ultrasound guidance, with permanent recording and reporting $46.18 $72.32
20605
Arthrocentesis, aspiration and/or injection, intermediate joint or
bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or
ankle, olecranon bursa); without ultrasound guidance
$37.95 $50.48
20606 with ultrasound guidance, with permanent recording and reporting $61.58 $79.48
20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g.,
shoulder, hip, knee, subacromial bursa); without ultrasound guidance $47.26 $60.86
20611 with ultrasound guidance, with permanent recording and reporting $61.58 $91.29
How can you guys make lots of money if you're only getting paid, for example, $72.32 for a joint injection that probably takes 15 minutes of office time?
