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Economics
Ultrasound is an incredibly useful tool for a practicing
emergency physician. Targeted ultrasounds can shorten
a differential and decrease the amount of time you spend
chasing dead ends. This, in turn, increases efficiency:
It decreases your patients’ waiting times and increases
the number of patients you can see per hour.
Example (without emergency ultrasound)
A 26 yo female with abdominal pain and vaginal bleeding
presents to your emergency department overnight. You
send a urine HCG and move her to a pelvic room for a
pelvic examination. The pregnancy test is positive and
you order a pelvic ultrasound to rule out ectopic pregnancy.
The ultrasound tech is called in. The ultrasound eventually
comes back normal intrauterine pregnancy.
TOTAL TIME—4 hours.
Example (with emergency ultrasound)
A 26 yo female with abdominal pain and vaginal bleeding
presents to your emergency department overnight. You
send a urine HCG and move her to a pelvic room for a
pelvic examination and ultrasound. You diagnose an intrauterine
pregnancy and arrange follow up.
TOTAL TIME—1 hour.
The easiest way to generate revenue from emergency ultrasound
is to bill for the ultrasound. In some emergency departments
this can be politically difficult, however the amount
of revenue possible makes it well worth your effort.
There are two sources of revenue from emergency ultrasound:
revenue from directly billing for the ultrasound procedure
and revenue from increases in the Evaluation and Management
(E&M) level Medicare billing. Ultrasounds that are
clinically indicated are billable under Medicare rules.
Additionally, the E&M level for the physician as well
as the institution may be increased due to the increased
complexity, diagnostic interventions, and decision-making
demonstrated with the use of bedside ultrasound.
Revenue from Ultrasound When NOT Directly Billing. Coding
and billing for patient care is based on Medicare rules.
This Evaluation and Management (E&M) system creates
a series of five levels that correspond to the amount
of revenue a patient encounter generates. The levels of
reimbursement are based on the principle that the more
work you do, the more you should get paid. By performing
emergency ultrasound in your emergency department, a percentage
of the patients you see will generate a higher level of
reimbursement.
Example (without ultrasound)
A 45 yo male diabetic presents with mild lower extremity
swelling and cellulitis. He does not want to be admitted
so you give IV antibiotics and send him out with a one
day follow up.
LEVEL 3 chart—Average compensation: $89.00
Example (with ultrasound)
A 45 yo male diabetic presents with mild lower extremity
swelling and cellulitis. He does not want to be admitted
so you give IV antibiotics, ultrasound his leg for a
suspected abscess and send him out with a one day follow
up.
LEVEL 4 chart—Average compensation: $145.00
For more information on billing please contact us by email
or phone. Additional information on increased revenue
from performing emergency ultrasound is in the Billing
and Coding Section of this webpage. |
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