Re: FW: [OB/GYN (OB)] RE: Direct Supervision for OBGYN
From: DuBose, Terry (DuboseTerryJ@uams.edu)
Tue Mar 28 09:11:30 2006
Joe, I do not understand this either. I am told by representatives to
the CMS that they are, "checking with SMFM to see where we stand on
getting this changed. I agree these are for the most part absurd and
likely the product of the fevered minds of cloistered bureaucrats."
I am not sure where this is coming from, but it is really out in left
field and has nothing to do with reality. But it does mean that
sonographers need to be contacting their Senators and Representatives
that this is bad for patient care and will increase the cost of that
care considerably.
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/
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-----Original Message-----
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From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
Joe Cutchin
Sent: Tuesday, March 28, 2006 9:53 AM
To: Multiple recipients of list ULTRASOUND
Subject: Re: FW: [OB/GYN (OB)] RE: Direct Supervision for OBGYN
sonography???
Terry:Help me understand this nonsense, please. Was this another
brilliant ACOG position? Joe C
DuBose, Terry wrote:
> 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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