Emergency Ultrasound Section Forum
Workflow and Data Management
Order to be Placed for Point of Care Ultrasound
I am curious how others are entering “orders" to perform
point-of care US.
Especially for those of us who don’t have a DICOM list
to work from or software to support this.
I am especially interested if you have Meditech.
It was recently brought to my attention that “an order”
has to be placed to properly bill for a study to meet criteria
for billing and reimbursement.
We have been reimbursed nevertheless over the years without placing such an “order."
We have templates placed in our procedure section of the EMR -
which includes the standard information:
Type of US study performed, indication/time performed/who is performing the study/views/findings and interpretation.
And all images are archived and QA performed.
Would simply placing an order in Meditech for (check)
“Point of care ultrasound” be sufficient and stating the indication
as we do know when we order other imaging studies?
What about the issue of self-referral?
Has this been an issue for anyone?
(i.e. I order a test that I perform.)
Thanks for the input in advance,
ED Ultrasound Director
South Shore Hospital
S. Weymouth, MA
We were forced into doing this about 3 years ago by our compliance folks. Essentially, they are looking for an ICD-9 (soon to be ICD-10) code to tie to your ultrasound exam. We created a list in our physician order entry system called "EMBU" orders. The physician can order the exam at any time during their stay. When placing the order, they are forced to choose the appropriate ICD-9 code as well. Initially, this created confusion for our nurses because of the way it came over in our order entry system. They didn't know if it was our study or a study to be done by Radiology. So, we altered the way the order came across, so that "ED performed" was included in the order line.
Another option that is also viable (according to our compliance office) is to state in your E&M note the indication for your US exam which the coders can then tie to an ICD-9 code. For example, "I performed an EFAST exam (indication: abdominal pain) that was positive for intraperitoneal free fluid."
The idea is that your E&M note (including orders) needs to stand alone as to why you did what you did. The fact that you place the indication for the ultrasound in your US report is not sufficient. At least that is the reasoning given by our compliance office. Surprisingly, the idea of placing an order for our own ultrasound exams, has gone over pretty well. There was confusion at first, but it works reasonably well now. If an order is not placed, the physician can always go back and amend their note, stating the indication for the ultrasound exam.
Hope that helps.
Robinson M. Ferre, MD, FACEP
Director, Emergency Ultrasound Division
Associate Program Director, Emergency Ultrasound Fellowship
Assistant Professor, Department of Emergency Medicine
Have a wonderful day to all
We use ICD-10, the option of ultrasonography without Radiologist, checked by the EP directly, recorded with the name of the EP, billed regularly nearly a 20 year.
Betul Gulalp, MD
Program Director of Emergency Ultrasound,
Asc.Prof, Dept of EM