ULTRASOUND Messages for December, 1997: Re: Medicare's new rules for sonograms

Re: Medicare's new rules for sonograms

From: DRoss38040

DRoss38040@aol.com

Mon Dec 15 23:13:51 1997

Diana Ross, RDMS << ************************************** From 10/31/97 E-mail <snip>

The Final Rules for Medicare for 1998 were published today, & Halloween would seem to be appropriate for some of the items included. The text can be downloaded from "http://www.access.gpo.gov/su_docs/aces/aces140.html" or may be ordered be credit card by calling 202.512.1800. I haven't finished a detailed review but there are some rather interesting changes, including those recently expected regarding supervision.

For example, virtually all procedures that are performed with ultrasound require either "direct" or "personal" supervision by physicians. HCFA provides the following comments: ""Direct supervision'' in the office setting does not mean that the physician must be present in the room when the procedure is performed; however, the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure." "We are defining ``personal supervision'' as follows: ``Personal supervision'' means a physician must be in attendance in the room during the performance of the procedure."

The assumption here is that (based on below noted comments received), in the out-of-hospital setting, ultrasound procedures are effective only when a physician monitors the performance of the procedure, this requiring the presence of the physician when the individual procedure is performed. A quote of the comments leading to this conclusion follows:

"Comment: Many physician commenters disagreed with our proposal to place diagnostic ultrasound procedures in the category of tests requiring general supervision. We received the following comments: <bullet> Most ultrasound diagnostic procedures should be placed in the direct or personal supervision categories. The requirement for general supervision is not sufficient to achieve the needed degree of physician input in the final product of the ultrasound examination. <bullet> Good ultrasound can only be performed through a working partnership between the technologist and the supervising physician. Commenters pointed out that radiologists frequently will examine the patient in real time to clarify uncertain findings or to further characterize pathology detected during the technologist's examination. If the physician does not go back to scan these patients himself, critical diagnoses would be missed. The common and correct practice of ultrasound is for a technologist to perform the examination and for a physician to check the study before the patient leaves the examining area. <bullet> The performance of ultrasound procedures requires more physician supervision than magnetic resonance imaging (MRIs), computerized axial tomography (CTs), or nuclear medicine procedures. <bullet> One commenter referred to unregulated ultrasound procedures in the U.S. as a ``cesspool of poor medical practice.'' <bullet> One commenter suggested that Medicare should prohibit payments for self-referred sonographic procedures performed by physicians who purchase this equipment for their offices and find reasons to use the equipment on their patients even though they are poorly-trained in the interpretations of the findings. <bullet> Several physicians commented that they often performed these tests personally without a technologist present."

All diagnostic ultrasound procedures of the head & neck, chest, abdomen & retroperitoneum, & spinal canal (76506 thru 76800 inclusive) require direct supervision. This is also true of the pelvic & extremity procedures with the exception of 76830 (transvaginal) & 76872 (transrectal), which require personal supervision. All of the ultrasound guidance procedures require personal supervision with the exception of 76950 (for placement of radiation therapy fields, b-scan) & 76960 (placement of radiation therapy fields, except b-scan), which require direct supervision.

With regard to echocardiography, direct supervision is required for all procedures except 93312(transesophageal), 93315 (transesophageal), & 93350 (stress). This review ignores 93313/4/6/7 (supervision policy does not apply). >>

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