Indeed, we at Coronis Health have noted in recent months an increasing interest on the part of our client base concerning the possibility of adding this care component to their normal anesthesia services. But what exactly is meant by point of care ultrasound?
Defining the Service
The term is not yet found in the Current Procedural Terminology (CPT) coding manual, so we will have to rely on other sources using the POCUS nomenclature. Here’s how it was defined by the American Society of Anesthesiologists in a March 2023 article:
Point of care ultrasound . . . can be defined as the use of ultrasound by a primary treating physician (e.g., an anesthesiologist) either to guide procedures or answer diagnostic questions, as opposed to a consultant physician who performs a comprehensive, high-level examination (not limited to procedures or diagnostic questions).
While not fully explanatory, one of the elements mentioned above that is said to differentiate POCUS from other ultrasound services is that POCUS involves limited, rather than comprehensive, views/usage of the ultrasound service. A blog dedicated to POCUS-related issues basically mirrors this same conclusion by noting “POCUS is classified as a limited ultrasound, defined as an ultrasound that is less comprehensive than a complete ultrasound.”
It should be noted that “a complete ultrasound involves the evaluation of various organs specified in the CPT manual associated with that code. If all these organs are not assessed, the ultrasound is considered limited.” The blog continues, “Since POCUS typically evaluates a specific organ for a particular condition, it typically does not meet the criteria for a complete exam.”
The Codes in Question
Numerous codes describe ultrasound services, but many (or even most) will rarely be submitted by anesthesiologists, according to the American Society of Anesthesiologists (ASA). Anesthesiologists typically use ultrasound to make diagnostic decisions or as guidance for certain procedures.
When reporting limited cardiac ultrasound examinations or focused exams of lungs, CPT® 76604, Ultrasound, chest (includes mediastinum), real-time with image documentation, may be beneficial.
When uncertainty exists regarding gastric contents or aspiration risk, gastric ultrasound can provide real-time information that helps anesthesia providers determine whether surgery can safely proceed, whether modifications to the anesthetic plan are warranted or whether postponement is appropriate. Beyond its clinical value, gastric ultrasound may also support reimbursement opportunities when appropriately documented and coded. Preoperative gastric ultrasound examinations that fall under POCUS may be reported using CPT® 76705, Ultrasound, abdominal, real time with image documentation; limited (e.g., single organ, quadrant, follow-up).
Documentation Requirements
Supporting the medical necessity of the POCUS service in the provider’s documentation is critical. For example, with cardiac ultrasound, documentation indicating an acute murmur found during the normal pre-anesthesia evaluation that was (a) not previously noted, and (b) needs further evaluation prior to administration of anesthesia, would be helpful in supporting medical necessity of the service.
The POCUS exam may be documented as a separate note or as part of the patient’s anesthetic record or daily progress note in addition to the physical exam. The ASA recommends the following documentation elements:
- Indication/medical necessity (not screening); ideally, the indication pairs well with an appropriate ICD-10 code
- Operator(s) who performed the exam
- Type of exam, including full vs limited and initial vs. repeat exam
- Findings in detail
- Interpretation of findings, including structures evaluated and relevant anatomy or pathology
Image Requirements
The CPT manual stresses that “all diagnostic ultrasound examinations require permanently recorded images with measurements, when such measurements are clinically indicated.” To submit claims for POCUS examinations, images must be saved and archived in a durable format and able to be reviewed for auditing for at least 5 years after the exam is performed. Local Medicare contractors may have additional requirements beyond these minimums, so anesthesia providers should review all local requirements to ensure compliance. The images/videos should clearly identify relevant anatomy and pertinent normal or abnormal findings to support the corresponding documentation.
If you’re thinking all this is a gimmick, hokum or hat trick, it’s not. POCUS is a legitimate, viable and billable service that anesthesia providers can consider adding to their current range of services.