ED Coding and Reimbursement Alert

Some ultrasound techniques are still new enough to emergency medicine that EDs don't always know the coding ropes - but that's no reason to leave reimbursement money on the bedside table. At a recent American College of Emergency Physicians (ACEP) coding and reimbursement meeting, Dennis Beck, MD, FACEP, chairman of the ACEP Reimbursement Committee and CEO of Beacon Medical Services, asked attendees how many groups were doing ultrasounds, and about 30 percent of the attendees raised their hands. "Then I asked how many people were coding and billing for ultrasounds done in their EDs, and no hands went up," Beck says. Historically, trauma surgeons and ED physicians haven't coded for these exams, says Stephen Hoffenberg, MD, FACEP, chairman-elect of the ultrasound section of ACEP and president of CarePoint, a 150-physician emergency group in Denver. "They just do them." Primary Indications in the ED Ultrasound is an evolving standard of care in emergency medicine, Hoffenberg says, and it has the extra advantage of being available at bedside. Bedside ultrasound in the ED can significantly accelerate patient care. "It's very quick to perform and it gives you essential diagnostic information that can be put into a clinical algorithm that will drive the care without requiring the patient be moved from the resuscitation suite to another part of the hospital."

Little guidance, however, has been provided in understanding the key elements of the coding or reimbursement for ultrasound procedures. CPT coding for many ultrasound procedures is straightforward, but in emergent settings unique variations arise.

ACEP policy specifically supports the use of ultrasound imaging by emergency physicians for several conditions: thoracoabdominal trauma, abdominal aortic aneurysm, pericardial effusion, ectopic pregnancy, and evaluation of renal and biliary tract disease. (Use of Ultrasound Imaging by Emergency Physicians [policy number 400121]). Speedy Coding for FAST Exams Emergency physicians frequently evaluate thoracoabdominal trauma using a two-part ultrasound examination. This examination is referred to by the acronym FAST, focused assessment by sonography for trauma.

"The first thing to understand about the exam," Hoffenberg says, "is that it's not a single procedure; it's actually a clinical approach to patients with blunt or penetrating trauma." Because of this definitional anomaly, he cautions, "you can't go to CPT and find a code for the FAST exam because it doesn't exist." Emergency coders need to understand that the FAST exam is not a single ultrasound procedure but a clinical approach to the trauma patient. However, two separate CPT codes describe limited ultrasound exams composing the FAST exam. Two Limited Parts of a FAST Exam:93308 and 76705 A FAST exam is composed of two separately identifiable procedures: One is a limited transthoracic echocar-diogram, the [...]