Medicare Compliance & Reimbursement - 2011 Issue 11
Ultrasound Coding: Probe Carefully to Ethically Maximize Ultrasound Reimbursement
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Article Overview
This article explains general ultrasound coding and billing considerations for emergency department and diagnostic imaging services. It focuses on CPT diagnostic ultrasound reporting, documentation and image-retention expectations, complete-versus-limited exam concepts, facility billing considerations, credentialing and payer barriers, and how ultrasound documentation may contribute to evaluation and management medical decision making. It is aimed at coders, emergency department billing staff, and clinicians involved in ultrasound documentation and reporting.
Why This Topic Matters
Ultrasound services are commonly scrutinized by payers, so accurate documentation and reporting can affect reimbursement and compliance. The article helps readers understand the broad issues that influence whether an ultrasound service may be separately reportable and how it fits into broader encounter documentation.
Article Sections
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Getting started
Introduces the diagnostic ultrasound portion of CPT and explains the general organization of the code family by anatomy and study type.
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Check These 4 Overarching CPT® Requirements
Summarizes broad documentation and reporting expectations associated with diagnostic ultrasound services, including recordkeeping and identification elements.
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Distinguish Complete vs. Limited exams
Discusses the distinction between complete and limited ultrasound exams and describes how that distinction relates to documentation and code selection at a high level.
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Be Aware of These Barriers to Successful Ultrasound Reporting
Reviews common operational and payer-related barriers that can affect whether ultrasound services are separately reported or reimbursed.
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Capture MDM Points for E/M With Ultrasound
Explains how ultrasound ordering and review may factor into evaluation and management medical decision making and includes example scenarios.
What You Will Learn
- How diagnostic ultrasound reporting is organized within CPT
- What kinds of documentation are generally expected for ultrasound services
- Why complete and limited ultrasound exams are treated differently
- Common operational and payer barriers affecting ultrasound billing
- How ultrasound activity may relate to evaluation and management documentation
Who Should Read This
- Emergency department coders
- Medical billers
- Physician practices
- Emergency physicians
- Ultrasound documentation staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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