Documentation Requirements for Emergency Department (ED) Ultrasound

1. Written Report/Interpretation
   1. Interpretation in the patient chart with the minimum of the following:
      1. Study performed
      2. Views obtained
      3. Findings
      4. Final interpretation
   2. When appropriate, note whether the exam is complete or limited.
2. Medical Necessity
   

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   1. Clearly state the indication for the study in the medical record.
   2. Payers often cross-check CPT codes with ICD-10 diagnosis codes—correct matching improves reimbursement and reduces denials.
3. Image Retention
   1. Images must be permanently stored and retrievable.
   2. A minimum of one image demonstrating relevant anatomy/pathology (with measurements if applicable) must be saved for each procedure coded.

 “Limited” versus “Complete” Ultrasounds

Ultrasound codes do not specifically reflect point-of-care ultrasound (POCUS); instead, we use the limited versus complete framework:

• Complete – involves evaluating all major structures within an anatomic region.
• Limited – includes only a subset of views.

For our purposes in the ED, POCUS exams are considered limited. These studies are performed to answer a focused clinical question or guide a procedure rather than exhaustively evaluate an entire organ system.

For a more detailed breakdown (advanced studies, procedural guidance, relative value unit comparisons), reach out to the ACEP Emergency Ultrasound (EUS) Subcommittee for extra resources.

Last, for even more info, check out ACEP’s Ultrasound FAQ.

Dr. Casey is an emergency physician and medical director of the emergency department observation unit at Wake Forest Baptist Medical Center in High Point, N.C., and director of ultrasound for the community hospitals. Dr. Casey is a member of ACEP’s Coding and Nomenclature Advisory Committee and chair of ACEP’s EUS Coding and Reimbursement Subcommittee.

References

1. Casey D, Lin YJ, Guttman J, Byouk J, Schoeneck J. Coding and reimbursement 101. ACEP. 2024. https://www.acep.org/emultrasound/subcommittees/coding-reimbursement.

2. Centers for Medicare & Medicaid Services. CMS-1832-F: Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule. CMS. Published November 5, 2025. Accessed May 25, 2026. https://www.cms.gov/medicare/payment/fee-schedules/physician/federal-regulation-notices/cms-1832-f (CMS)

3. Centers for Medicare & Medicaid Services. CY 2026 PFS Final Rule Codes Subject to Efficiency Adjustment.xlsx. CMS. Updated November 17, 2025. Accessed May 25, 2026.