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FW: [OB/GYN (OB)] RE: Direct Supervision for OBGYNFrom: DuBose, Terry (DuboseTerryJ@uams.edu)Tue Mar 28 07:58:56 2006
Don. Thanks for getting this information, even though it is very disturbing. In 30 years of sonography I have never had to have "Personal Supervision" for these examinations. In fact, I have never had "Personal Supervision" for the initial part of any sonographic examination; though I have often requested a chaperone for Endovaginal and Breast exams, the chaperone was never a physician. The only time a physician has come into the exam room with me was in very complex cases which required real-time observation and I requested or suggested the physician's presence so that she/he could understand the pathological process; or during biopsies, which the physician was performing. It is my opinion that NO ONE is following these guidelines, and it indicates to me that either the CMS bureaucrats do not understand sonography at all, or that they are not hearing (or listening to) our professional representatives. It is urgent that this situation be corrected. These are regulations that are completely out of touch with reality. The level of supervision required for OB codes is: (*indicates personal supervision): *76801 - Obstetrical ultrasound, less than 14 weeks, single fetus; personal supervision *76802 - Obstetrical ultrasound, less than 14 weeks, additional fetus; personal supervision *76811 - Obstetrical ultrasound, detailed, single fetus; personal supervision *76812 - Obstetrical ultrasound, detailed, additional fetus; personal supervision *76817 - Transvaginal obstetric ultrasound; personal supervision Please see Don's entire message below. Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM Associate Professor & Director Diagnostic Medical Sonography Program University of Arkansas for Medical Sciences, CHRP 4301 West Markham St. Mail Slot #563 Little Rock, Arkansas, 72205 USA 501-686-6510 DuBoseTerryJ@UAMS.edu http://www.uams.edu/chrp/sonography/ http://www.obgyn.net/us/panel/panel.htm http://www.io.com/~dubose/ --------------------------------------------------------------- quote: --------------------------------------------------------------- To: SDMS Members --------------------------------------------------------------- From: Donald F. Haydon, SDMS Executive DirectorRe: OB Supervision Requirements When a recent posting on the ACOG website raised the issue of sonographer supervision requirements for a specific set of OB codes, SDMS filed a request with our Washington D.C. based lobbyist/legal counsel to check with CMS to confirm the information. The ACOG information indicated that a set of commonly performed OB ultrasound exams were now subject to 'personal' supervision. We have now received our response. The current situation is as follows: The level of supervision required for OB codes is: (*indicates personal supervision): *76801 - Obstetrical ultrasound, less than 14 weeks, single fetus; personal supervision *76802 - Obstetrical ultrasound, less than 14 weeks, additional fetus; personal supervision 76805 - Obstetrical ultrasound, 14 or more weeks, single fetus; general supervision 76810 - Obstetrical ultrasound, 14 or more weeks, additional fetus; general supervision *76811 - Obstetrical ultrasound, detailed, single fetus; personal supervision *76812 - Obstetrical ultrasound, detailed, additional fetus; personal supervision 76815 - Obstetrical ultrasound, limited, fetus(s); general supervision 76816 - Obstetrical ultrasound, follow-up, per fetus; general supervision *76817 - Transvaginal obstetric ultrasound; personal supervision 76818 - Fetal biophysical profile with non-stress testing; general supervision 76819 - Fetal biophysical profile without non-stress testing; general supervision 76825 - Echo exam of fetal heart; general supervision 76826 - Echo exam of fetal heart; general supervision 76827 - Echo exam of fetal heart; general supervision 76828 - Echo exam of fetal heart; general supervision Description of supervision levels: General supervision - means the procedure is furnished under the physician's overall direction and control, but the physician's presence is not required during the performance of the procedure. Direct supervision - means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. Personal supervision - means the physician must be in attendance in the room during the performance of the procedure. There was no rationale provided for the five OB codes requiring the higher level of personal supervision. Prior to 1999, most OB codes were assigned personal or direct supervision. Then, in response to public comments on the physician fee schedule for 1999 and our advocacy efforts HCFA (now CMS) provided carrier manual instructions that revised the level of supervision for many diagnostic services, changing many OB codes from personal or direct to general supervision. However, the five OB codes at issue did not exist when HCFA provided these carrier manual instructions. Therefore, personal supervision may have been assigned to these five OB codes in error by referencing the original level of supervision required for most ultrasound procedures prior to 1999. SDMS will be working to address this issue and will seek to collaborate with other organizations to request reconsideration/re-classification of the OB codes that require 'personal' supervision. Peace, Terry J DuBose, M.S., RDMS http://www.io.com/~dubose/
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