Original ContributionImplementation of a novel point-of-care ultrasound billing and reimbursement program: fiscal impact☆,☆☆,☆☆☆,★
Introduction
The use of point-of-care (POC) ultrasound in the evaluation of emergency department (ED) patients has grown rapidly in both academic and private settings [1]. POC ultrasound has emerged as an important tool for rapid diagnosis of serious and life-threatening conditions in the ED [2]. Prior studies have demonstrated that emergency physician-performed bedside ultrasound improves diagnostic accuracy and decreases length of stay [3], [4]. The use of ultrasound for procedural guidance has been shown to be cost effective and to decrease complication rates [5]. Bedside ultrasound education has become an essential component of emergency medicine (EM) residency training and residents are required to demonstrate competency in performing bedside ultrasound to meet the Accreditation Council for Graduate Medical Education milestones [6].
The American College of Emergency Physicians (ACEP) Emergency Ultrasound Guidelines outline the scope of practice of emergency ultrasound, training pathways, credentialing, documentation, ultrasound equipment, and quality assurance (QA) process [7]. Successful implementation of an emergency ultrasound program requires financial integration of ultrasound into existing departmental billing and coding. A comprehensive document that addresses emergency ultrasound coding and reimbursement was developed by ACEP and recently updated [8]. This document provides guidance for appropriate emergency ultrasound documentation, current procedural terminology (CPT), International Classification of Diseases-9 coding, payer policy, and reimbursement. There are significant costs associated with an emergency ultrasound program including physician education, appropriate ultrasound equipment, an image archival system, QA, ultrasound machine, and probe maintenance. The development of ED ultrasound billing and reimbursement program is therefore crucial to cover these costs and to provide incentives for emergency physicians who perform ultrasound examinations. To date, very little has been published regarding the financial implications of an ED ultrasound program. The objective of this study was to determine the fiscal impact of implementation of a novel ED POC ultrasound billing and reimbursement program.
Section snippets
Study design
This is a single-center retrospective study at an academic medical center with an annual ED census of 70 000 visits. The study data were collected during fiscal year 2013. Institutional review board approval was obtained for this study protocol.
Study setting and population
The study was conducted in an ED with a 3-year EM residency program and a 5-year EM/pediatrics combined residency program with 49 faculty members. The department offers fellowships in ultrasound, Emergency Medical Service, Toxicology, Sports Medicine, and
Results
After the implementation of the new billing program there was a 45% increase in ED faculty participation in billing for patient care examinations (30%-75%). ED coding staff ensured that all ultrasound examinations billed had appropriate documentation required for billing. Compared to the previous year, the number of ultrasound examinations billed increased 5.1 fold (4449 vs. 857) during the post implementation period. The total units billed increased from previous year for professional services
Discussion
The scope and indications for POC ultrasound in emergency medicine are rapidly growing across the nation. Use of ultrasound in the ED has been shown to improve patient care and is becoming standard practice. Development of a financially viable emergency ultrasound program is essential to cover the costs of implementation (capital, training, and maintenance). A fiscal analysis done by Soremekun et al described actual and potential return on investment for their ED ultrasound program based on
Conclusions
Within 1 year of inception, our novel POC ultrasound billing and reimbursement program generated significant revenue through ultrasound billing. The key components of our billing program included Web-based image archival system for documentation, ongoing faculty and resident education, timely QA review with continuous billing reminders, regular interaction with ED coders, productivity reports, and support from the ED leadership and hospital administration.
Acknowledgments
The authors thank Kelly Kellen for her assistance with implementation of ultrasound billing protocol.
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Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine
2023, Annals of Emergency MedicineAssociation of thoracic cage fractures and pericardial effusion in blunt trauma
2021, American Journal of Emergency MedicineCitation Excerpt :One particular aspect of clinical practice that may be directly impacted, by this evolution in our understanding of the underlying pathophysiology and evaluation of blunt thoracic trauma, is the cardiac component of the FAST exam. It is becoming increasingly common for an ED to bill for each individual view of a bedside FAST examination [12]. In addition, since clinically important pericardial effusions are so rare, many authors have questioned the utility of the cardiac view as a screening modality in blunt chest trauma [13,14].
eFAST exam errors at a level 1 trauma center: A retrospective cohort study
2021, American Journal of Emergency MedicineCitation Excerpt :Many trauma patients undergo Extended Focused Assessment with Sonography for Trauma (eFAST) imaging in the emergency department to rapidly diagnose internal bleeding and identify patients who need operative management [1,2]. The eFAST exam is a useful diagnostic tool which has been shown to decrease time to operative therapy as well as resource utilization for trauma patients [3]. Clinicians may perform the eFAST exam during a comprehensive trauma evaluation in order to determine the next steps in the patient's care (e.g. surgery, computed tomography scan, interventional radiology (IR) procedure, etc.) and disposition planning.
Impact of an epic-integrated point-of-care ultrasound workflow on ultrasound performance, compliance, and potential revenue
2021, American Journal of Emergency MedicineCitation Excerpt :While our workflow is also automated and implements a billing protocol, it accomplishes this within the EMR alone in a way that is just as intuitive for physicians to use. A 2014 study by Adhikari et al. showed that implementation of a PoCUS workflow resulted in a greater than five-fold increase in billable PoCUS examinations performed and a 45% increase in ED faculty PoCUS participation, with a final workflow compliance rate of 75% [4]. A study in 2017 by Flannigan et al. found improved compliance and net increases of 96% and 78% in technical and professional fee revenues, respectively, after launching their PoCUS workflow, despite noting an overall decrease in PoCUS examinations [3].
Practical Aspects of Point-of-Care Ultrasound: From Billing and Coding to Documentation and Image Archiving
2021, Advances in Chronic Kidney DiseaseCitation Excerpt :After implementation of this process, there was a significant increase in billing, specifically a 96% increase in net technical revenue and a 78% increase in professional revenue.13 Similarly, another study demonstrated improvement in billing and revenue after implementation of a web-based archival system, Qpath, with automatic image transfer and immediate completion of worksheets linked to specific CPT codes.17 Simply creating a dedicated workflow task force has also demonstrated improvements in documentation compliance and coding and billing.18
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Abstract presented at the American Institute of Ultrasound in Medicine Annual Convention, Las Vegas, NV, March 2014.
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All authors declare that there is no conflict of interest.
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Disclosures: None.
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Reprints not available from the authors.