The things that have revolved around the ultrasound are in fact a truth that has occurred over the last several years. Physician practices now who own an ultrasound machine are 1.5 times more likely to order an ultrasound study than those who refer for a study.
Payers are not oblivious to this information. They have been looking at ultrasound's overutilization for quite some time. And some of you may even notice that the OIG who's more interested in what Medicare is doing or not, the commercial payers, is looking into that very area of overutilization of ultrasounds. Of course in their population, we would hope that they're not looking at pregnancy ultrasounds.
But the problem – that the reason for the ultrasound is not always appropriate for the condition being evaluated. Sometimes, the training of the physician or the sonographer who is performing it or the physician who is interpreting it may not be clinically appropriate for the payer. So, they are looking at the frequency of the ultrasounds. They are looking at basic protocols. They're looking at the diagnosis code. And they're also looking at certification.
All of these factors can contribute to your not being able to be reimbursed for the ultrasounds being performed in your office. Now, there are some recognized standards – the America Institute of Ultrasound in Medicine and the American College of Radiology and of course, the American College of Obstetricians and Gynecologists. And of course, the CPT book have all published information.
Types of Ultrasound Scans
Now, the basics of ultrasound, there are some standards. The standard ultrasound is usually a B-scan. It's real time. It's two dimensional which means it's that fuzzy, gray picture that you see that doesn't give a whole lot of detail. And sometimes when you look at it, we say, “Huh? That's a baby in there? What does that look like?” Usually the display will do some motion in time. And this will apply to both the OB and GYN scans.
A duplex scan is another form of scanning. And this is when they look at the direction of the arteries and the veins. And it's a real time image of course. And you can have some color added to that in the form of color flow Doppler mapping or imaging. This is done again, to look at arteries and veins. We're trying to see where the blood flow is going to and from. Either one of these can be done through a transvaginal or a transabdominal mode. And we don't always however have a code that specifies the route that's going to be done for the ultrasound.
Doppler is also something else that can be done. Normally, Doppler is added when you want to see again, the blood flow characteristics in the fetal blood vessels. And this can also be done via either an abdominal or vaginal route.
The 3-D Ultrasound
As far as technology is concerned, we have 3-D ultrasound now. A lot of payers still consider it investigational unless there's some really documentation as to why it's necessary, why the standard scan that was performed was inadequate. This might particularly be the case when you suspect a fetal anomaly and normal ultrasound is just simply not picking it up.
But the fact that you can identify it may not tip the scales for payer because what they want to know is, “Well, then can you do anything about it?” If the answer is, “No”, then in their view, the 3-D ultrasound is not adding to the care of the patient. Therefore, they may not reimburse for it. But it gives a lovely 3-D picture of either the fetus, the picture of tumors and other anomalies.
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