Coding Common Bedside Ultrasound Exams? Not so FAST!
Proper coding requires capturing all elements of focused abdominal sonography for trauma in the medical record.
Ultrasound equipment has become smaller and more portable, and the images produced are of high quality. As such, bedside ultrasound exams are performed frequently in emergency departments and trauma centers. These bedside ultrasound exams are referred to as FAST exams. “FAST” is an acronym for “focused abdominal sonography for trauma” exam, but these exams are not limited to the abdominal area. For example, the detection of a pneumothorax was included in the “eFAST” protocol in 2004. “eFAST” is an acronym for “extended focused assessment with sonography in trauma.”
In many trauma triage cases, providers try to identify free fluid, hemorrhage, and other abnormal fluids, such as urine and bile, in the abdominal, peritoneal, pericardial, pleural, or retroperitoneal spaces, and to do so as quickly as possible. A computed tomography (CT) scan is better than an ultrasound but is difficult to perform quickly and at bedside. An eFAST exam can detect smaller amounts of fluid than a chest X-ray, and it has largely replaced the peritoneal lavage as the primary method to detect free intraperitoneal fluid.
Call on Four Codes for Coding and Billing
There is not a single CPT® code to report all components of a FAST exam. Depending on the area(s) examined, one to four distinct limited ultrasound codes may be billed:
- The cardiac component of the exam is reported using 93308 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study.
- The intraperitoneal component of a FAST exam is reported using 76705 Ultrasound, abdominal, real-time with image documentation; limited (eg, single organ, quadrant, follow-up).
- The retroperitoneal component is reported using 76775 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited.
- When evaluating for the presence of a hemothorax or pneumothorax, the thoracic component of the exam is reported using 76604 Ultrasound, chest (includes mediastinum), real time with image documentation.
When coding, it’s important to determine whether the study was complete, limited, or reduced. CPT® defines a complete exam and a limited exam for abdominal and retroperitoneal ultrasounds and transthoracic echocardiography; however, CPT® does not differentiate between a limited or complete chest ultrasound because there is only one procedure code to report this service. Usually, the FAST exams are of a limited nature.
Most of the time, FAST and eFAST exams are performed in facility settings, such as emergency rooms or at bedside in the inpatient environment; and, as such, the equipment is usually provided by the facility. For professional billing, the physician or other qualified healthcare practitioner appends modifier 26 Professional component to the procedure code.
These exams may be performed in non-facility settings, such as non-hospital-based urgent care centers. If the equipment is owned by the urgent care center and the interpretation is performed by the urgent care center provider, then the service may be billed globally for both the technical and professional components.
General Documentation Requirements
The medical record documentation must indicate why the test was medically necessary (study indications). A written interpretation and report must be completed and maintained in the patient’s medical record. The interpretive report must describe the structures or organs studied, along with any abnormalities encountered, and an interpretation of the findings. Facilities must maintain the written interpretation in the patient’s medical record along with images, videotape, or digital data of the relevant anatomy evaluated. The report needs to clearly identify who performed the procedure and who provided the interpretation.
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