Emergency Ultrasound Section Forum
General EUS Topics
Discussion with Radiology Re. POCUS
After a (somewhat) successful discussion with radiology about billing for POCUS, the Head of Radiology at my hospital asked me to refer him to some other hospitals that have both billing for ED POCUS in place AND a private radiology group in place. Presumably, he’d like to call them and see how it turned out and to see what kind of negotiation was reached there. In the hopes of these discussions remaining civil I was hoping some of you might help me direct him to places that have worked well for both parties. Has anyone had this turn out well (or at least somewhat cordial) at their shops?
Director of Emergency Ultrasound
Crozer Hospital, Chester PA
This looks like a similar battle I went through 10 years ago.
Do you have a critical mass of docs trained and credentialed? I would recommend getting to that stage before discussing billing. You can always do a projected return on investment.
The best approach his to arrange a meeting between him, your chair, you and chief of medical staff for the hospital to discuss value of point of care ultrasound. Make it all about quality of care, safety, patient satisfaction, benchmarks. At this point it is almost standard of care with some applications. Obviously since US is a DIAGNOSTIC TEST (see ACEP clinical policy statements) you should be billing for services.
Use the ACEP US section website resources: imaging compendium, guidelines, ect
If your department bills for xray interpretations ask the Radiologist why they don't complain about that.
Print the following document and bring it to the meeting:
H-230.960 Privileging for Ultrasound Imaging
(1) AMA affirms that ultrasound imaging is within the scope of practice of appropriately trained physicians;
(2) AMA policy on ultrasound acknowledges that broad and diverse use and application of ultrasound imaging technologies exist in medical practice;
(3) AMA policy on ultrasound imaging affirms that privileging of the physician to perform ultrasound imaging procedures in a hospital setting should be a function of hospital medical staffs and should be specifically delineated on the Department’s Delineation of Privileges form; and
(4) AMA policy on ultrasound imaging states that each hospital medical staff should review and approve criteria for granting ultrasound privileges based upon background and training for the use of ultrasound technology and strongly recommends that these criteria are in accordance with recommended training and education standards developed by each physician’s respective specialty.(Res. 802, I-99; Reaffirmed: Sub. Res. 108, A-00; Reaffirmed: CMS Rep. 6, A-10)
Read your hospital bylaws and make sure there is no malignant clause in there saying radiology controls all hospital imaging. If there is, change it or find a new place to practice.
Radiology has zero say in your right to perform and bill for ultrasound. IF it makes them feel better you can get a list of many places that are billing for it including my hospital but it really should not be needed.
The most important thing is to make sure your chair is with you on this and willing to attend the meeting.
Feel free to contact me offline for more advice on this.
Rajesh N. Geria MD
Brunswick Urgent Care, PA
Clinical Assistant Professor
Rutgers Robert Wood Johnson Medical School
New Brunswick, NJ
Past Chair, ACEP Ultrasound Section
Board of Directors, NJ ACEP
Regarding your concern from radiology- If the ED bills for a LIMITED study and radiology bills for a complete study then these are different exams and both bills should pass through. However, when similar exams are done on the same day, CMS may only reimburse the facility fee at the bundled ambulatory payment classification (APC) rate.
They will still reimburse the professional fee for both.
If however both depts performed the same study and placed bills for each, the insurance company will pay whomever submitted the bill first. The places where rads and EM worked out deals best is agreement about which studies each dept would bill for. In those cases EM billed for line placement, FAST, exams, and cardiac exams in patients in extremis, (cases for which rads did not have to come out of their reading room) and Rads billed for pelvics, gall bladders, and renals (usually more stable patients). Most radiology depts are so busy that to have EM do those handful of POCUS studies is really helpful for them. Another agreement which seems to have worked is that when EM does its limited study but then send the patient for a radiology scan, for EM not to bill those exam - only submit bills for ones which patients did not go to radiology.
-Jennifer Marin & Stan Wu
I’ve had this argument with several community radiology departments now, and one offer that has worked in every case is to suggest they take a look in a year. If they can demonstrate that our billing has made an impact on their business, we’ll revisit the issue. Not that I believe any radiology department would find an impact, but in every case they have seemed satisfied with that suggestion and I’ve yet to see anyone even bother to take a look.
Hawaii Emergency Physicians Associated