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ACE Alert: Images matter

ULTRASOUND GUIDANCE
Radiology documentation needs to be checked.
 
It is becoming more common for audits to challenge the radiology component for lines and post-operative pain blocks.  In reviewing the NCCI Radiology Chapter 9, the ACE team wants to remind providers of what is required for billing. We have bolded what we believe will be the critical element reviewed if challenged.
  • When a central venous catheter is inserted, a chest radiologic examination is usually performed to confirm the position of the catheter and the absence of pneumothorax. Similarly, when an emergency endotracheal intubation procedure (CPT code 31500), chest tube insertion procedure (e.g., CPT codes 32550, 32551, 32554, 32555), or insertion of a central flow-directed catheter procedure (e.g., Swan Ganz)(CPT code 93503) is performed, a chest radiologic examination is usually performed to confirm the location and proper positioning of the tube or catheter. The chest radiologic examination is integral to the procedures, and a chest radiologic examination (e.g., CPT codes 71010, and 71020) should not be reported separately.
  • Fluoroscopy reported as CPT code 76000 is integral to many procedures including, but not limited, to most spinal, endoscopic, and injection procedures and shall not be reported separately. For some of these procedures, there are separate fluoroscopic guidance codes that may be reported separately. (CPT code 76001 was deleted on January 1, 2019.)
  • CPT codes 76942, 77002, 77003, 77012, and 77021 describe radiologic guidance for needle placement by different modalities. CMS payment policy allows one unit of service for any of these codes at a single patient encounter regardless of the number of needle placements performed. The unit of service for these codes is the patient encounter, not the number of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations.
  • Providers/suppliers reporting services under Medicare’s hospital Outpatient Prospective Payment System (OPPS) shall report all services in accordance with appropriate Medicare “IOM” instructions.
We recently did have experience with a UHC policy that specifically instructed that the retained image must show the final placement of the needle.  Services were denied as the verbiage did not include evidence of real-time image guidance and the image retained did not show the final placement of the central line.  The payors are looking for any reason to take the money back on these ancillary services.

Good reference material is the AIUM Practice Parameter for Documentation of an Ultrasound Examination.  Providers need to understand that they will be held to the same standards as a radiologist when billing these codes.  

When was the last time you pulled your ultrasound guidance or radiology documentation and checked to be sure that it is well documented?  This is definitely a to-do on the compliance checklist!  Please contact us if you would like a focused review on checking your documentation! 

Susan West, RHIT
The ACE Team
913-648-8572
aceadmin@aceauditors.com 

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