Re: FW: [OB/GYN (OB)] RE: Direct Supervision for OBGYN sonography???
From: Joe Cutchin (forcep@intercom.net)
Tue Mar 28 09:40:14 2006
If I had to make a guess ,this is a product of The American College of
Radiology in attempt to excludes others. Sorry about my cynical view:
I've been around too long. Joe
DuBose, Terry wrote:
> 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/
> ---------------------------------------------------------------
>
> ---------------------------------------------------------------
>
> ---------------------------------------------------------------
> -----Original Message-----
> 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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