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Outpatient Facility Coding Alert

Diagnostic Details:

Get a Clear Image of Ultrasound Coding to Claim It Right

You may need to code ultrasound more frequently in your office settings.

Physicians have used ultrasound to view and help diagnose female gynecological conditions for years, but now ultrasound is becoming increasingly prevalent in office or outpatient settings for other specialties such as urology, ophthalmology, and orthopedics.

Refresher: In ultrasound or sonography, images are made by sending pulses of ultrasound waves into tissue using a probe. The sound echoes off the tissue or areas being scanned and are then imaged and recorded.

The CPT® manual offers a wide range of codes for ultrasound that are similar to traditional X-ray codes. So beware! Analogic ultrasound codes make no guarantees concerning reimbursement or coverage. It is the responsibility of the provider to determine and submit appropriate codes, modifiers, and claims for services rendered.

Document the Images and Record Everything

You need to maintain the written reports of all ultrasound studies in the patient’s record. You may adopt either of the following ways to record:

  • For ultrasound guidance procedures, the written reports may be filed
  • as a separate item in the patient’s record or
  • included within the report of the procedure for which the guidance is used.

You can store records as printed images or on a tape or electronic medium that’s kept in the patient record or some other archive (they are not required to be submitted with the claim).You may have to produce these documents if the insurer requests you to do so.

Understand the Payer’s Payment Policies

Medicare Part B will reimburse physicians for medically necessary diagnostic ultrasound services, provided the services are within the scope of the physician’s license. Some Medicare carriers require the physician who performs and/or interprets some types of ultrasound examinations to demonstrate relevant, documented training through recent residency training or post-graduate CME and experience. You should contact your Medicare Part B Carrier for details.

Private insurance payment rules about which specialties may perform and receive reimbursement for ultrasound services vary by payer and plan. Some payers will reimburse providers of any specialty for ultrasound services while others may restrict imaging procedures to specific specialties or providers possessing specific certifications or accreditations. Some insurers require physicians to submit applications requesting ultrasound exams and procedures be added to their list of services performed in their practice.

Note: It is important to contact your private payers before submitting claims to determine their requirements and request that they add ultrasound to your list of services.

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Outpatient Facility Coding Alert

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