Question: How can I be reimbursed for performing and interpreting my bedside point-of-care ultrasound (POCUS)?
Answer: According to Current Procedural Terminology (CPT), to properly bill for POCUS, physicians must document the report and store the images permanently. Physicians need not have performed the ultrasounds themselves in order to bill. Except in special circumstances (eg, repeat focused assessment with sonography for trauma [FAST] examination or echocardiogram when the patient deteriorates), Medicare and many other payers will only pay for one interpretation and report for a given category of ultrasound per day.
Explore This IssueACEP Now: Vol 38 – No 07 – July 2019
Where possible, report a diagnosis or complaint that describes the indication and/or the medical necessity for the ultrasound. Ideal documentation would include the indication, a description of the findings related to the reason for the study, your interpretation, and, when available, comparison to previous images. There is no rule requiring the report be on a separate page or note of the electronic health record, but highlighting it as a special section within your ED note is strongly recommended.
Typically, emergency physicians perform limited studies, as we don’t comment on all the required elements of a complete study of a given anatomical area. Some common limited POCUS CPT codes used in the emergency department include 76815 (ultrasound, pregnant uterus), 76705 (ultrasound, abdomen), 93308 (echocardiogram), 76775 (ultrasound, retroperitoneum or renal), and 76604 (ultrasound, chest). When a code for limited ultrasound is not available (eg, transvaginal ultrasound), the -52 modifier is appropriate along with the -26 modifier. When the ultrasound machine is owned and maintained by the hospital, you would use the -26 modifier to stipulate that you are only billing for the professional component of the ultrasound.
See ACEP’s ultrasound FAQs for more details.
Brought to you by the ACEP Coding and Nomenclature Committee.
Dr. Friedenson is chair of ACEP’s Coding and Nomenclature Committee and the chief medical officer of Reventics in Denver.