Supporting PCP Financial Stability with Reimbursement Codes for Diagnostic Procedures 700 467 GE Healthcare Staff

Supporting PCP Financial Stability with Reimbursement Codes for Diagnostic Procedures

In today’s rapidly changing healthcare industry, properly utilizing reimbursement codes for diagnostic procedures can help primary care providers (PCPs) capture revenue, helping to keep their bottom lines strong and their doors open. It’s imperative that clinicians not only know how to properly capture payment for the services they offer but that they make time to do so as well.

Reimbursement Codes and Handheld Ultrasound

PCPs are stretched thin on a daily basis. According to one news report, they average 24 phone calls; 17 emails; 12 prescriptions; and 40 lab, X-ray or specialist consults –  all while juggling a load of nearly 30 patients each workday. Add on the time spent entering patient information into the electronic medical record, and it can be tough for doctors to ensure that they accurately bill for the care rendered. Consequently, it’s vital for providers to stay on top of processing billing information each day to avoid falling behind, forgetting what they’ve done and losing money.

Additionally, the push to spend more time with each patient means that providers will, potentially, need to cut down on their patient load, which could reduce revenues even more. With fewer patients, it will be even more critical for providers to capture all possible reimbursements in order to continue serving patients.

Requirements for Handheld Ultrasound Billing
Capturing the necessary information to bill for some services can prove difficult. For example, in many cases, PCPs use handheld ultrasound as a tool to further investigate a patient’s symptoms at the bedside. Details gleaned from these images can help the physician rule out a need for further medical intervention or alert a provider to a problem that could require emergent or specialist attention. The exam itself can be invaluable, but how it’s performed determines which reimbursement codes the provider should use.

To bill for handheld ultrasound, a provider must make sure that the service fulfills particular requirements:

  • The service must be medically reasonable and necessary for diagnosis and treatment.
  • The service must serve the same purpose as a standard ultrasound.
  • The image quality must be good enough to not require follow-up imaging.
  • The service must be performed, and the images must be interpreted by a qualified professional.
  • The necessity, images, findings, interpretation and report must be included in the medical record.

Once these requirements are fulfilled, PCPs must choose the proper reimbursement codes for medical devices, as well as the correct modifiers, to ensure they get paid appropriately.

Codes and Modifiers

Getting paid for these ultrasound exams can sometimes be difficult, particularly because many PCPs don’t know which reimbursement codes for medical devices to use, or even which services they can request for reimbursement. It’s possible for providers to be paid for a variety of services — including vascular, abdominal and echocardiography as well as other types of ultrasound exams — but they need to provide the correct code for processing.

Medicare has set payments for each ultrasound service, but providers need to reach out to private payers to determine their reimbursement rates. For example, Medicare currently reimburses PCPs approximately $30 for a handheld abdominal ultrasound, as well as nearly $26 for an aorta ultrasound. PCPs need to contact private payers to determine how much they will be reimbursed for diagnostic and interventional ultrasounds.

Frequently, though, simply providing the right code isn’t enough for successful reimbursement processing. Attaching a modifier can make it clear whether a claim is for services provided by a doctor or a technologist. It can also signify whether there were any changes to how the ultrasound is regularly provided. Consequently, to code properly, doctors need to be familiar with these modifiers:

  • -26: Professional Component
  • -TC: Technical Component
  • -52: Reduced Services at Physician Discretion
  • -76: Repeated Service by Same Physician
  • -77: Repeated Service by Another Physician

Ultimately, having a better understanding of reimbursement codes for medical devices is paramount for PCPs to secure and maximize payments for the care they provide. Even though it can add a task to the already long workday, taking the time to code correctly can keep a doctor’s practice financially healthy.

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