Re: Ultrasound forum??! Help Me! Stir the pot!
From: art fougner, md (evsono@pipeline.com)
Fri Mar 7 16:57:56 2008
Fortunately, I don't see all that many Medicare nuchals.
Art
At Fri, 7 Mar 2008, Terry DuBose wrote:
>
>Jim, thanks for stirring us up, again.
>
> What about nasal bones, is anyone measuring them routinely?
>
> On the subject of NTs, are you aware that according to the CMS the NT exam (76813 and 76814) must be under "personal supervision" of the physician? The following is from the SDMS Sound News archive for February. While I am no longer scanning, just teaching, I know that NT measurements are being done by sonographers under "general supervision," not "personal supervision", yet that constitutes fraud according the the CMS.
>
> What are your thoughts on this?
>
> Terry
>
> 3. SDMS Works with CMS to Update Obstetrical Codes
> Last year, SDMS contacted the Centers for Medicare and Medicaid Services (CMS) regarding their assignment of “personal supervision” (supervising physician must be in the room while the exam is performed) to the following five obstetrical ultrasound codes:
>
> 76801—Obstetrical ultrasound, less than 14 weeks, single fetus
> 76802—Obstetrical ultrasound, less than 14 weeks, additional fetus
> 76811—Obstetrical ultrasound, detailed, single fetus
> 76812—Obstetrical ultrasound, detailed, additional fetus
> 76817—Transvaginal obstetric ultrasound
> SDMS successfully argued that the level of supervision was inconsistent with Medicare standards and CMS’s application of those standards to other diagnostic ultrasound procedures. We are pleased to report that in the January 3, 2008 “National Physician Fee Schedule Relative Value File,” the five obstetrical codes have now been reset to "general supervision" (supervising physician must be available, but does not have to be in the exam room or the facility). Two other OB related codes dealing with nuchal translucency (NT) exams -- 76813 and 76814 -- remain unchanged and still require the personal supervision standard. SDMS is working with other medical organizations to encourage CMS to reconsider the NT code supervision requirements.
>
>jworrall@alaska.net wrote:
> OK, I shall stir a bit. I do NT but find it is very time consuming. As our
>patients become more obese, it becomes more and more difficult. I have not
>bothered becoming certified in the nasal bone, because I did not think it
>was worth the money and effort, and it would just make scans all the more
>time consuming. And while I am at it, let me ask a question. Do you
>recognize that 76813 and 76817 are different? If a patient is sent to you
>for "nuchal translucency", or "first trimester genetic screen", do you do
>anything besides CRL and NT? Do you ever charge both 76813 and 76817? If we
>are not allowed to discuss these things, then do not respond.
>
>I do not check all cervices at 18-32 weeks. I do not require a full bladder
>for transabdominal obstetrical scans and I do not see the cervix well
>transabdominally in most patients. I am of the school that the only way to
>look at the cervix is transvaginally. I also am of the feeling that I should
>not charge for exams that were not formally requested by the referring
>provider. I do not want to do a transvaginal scan routinely, without
>compensation of some sort. It is quite a bit of work and time for my nurse
>to sterilize the transvaginal probe. I agree that the cervix should be
>checked, but isn't it up to the obstetrical provider to order that? I guess
>if one has all obstetrical patients arrive with a very full bladder, you
>will be able to evaluate the cervix transabdominally in many patients. Then
>it is not a problem. Still, there is hardly a week goes by that I do not
>have to scan at least one patient that weighs 250-300 lbs. The vast majority
>of pregnant patients I see weigh more than I do. It is becoming a huge
>problem.
>
>I have missed your always-significant contributions, Jim. Please do not give
>up on this forum. Another forum to look at is Yahoo Group's Medical Imaging
>forum. http://health.groups.yahoo.com/group/medicalimaging/?yguid=7595043
>
>Allen
>
>--------------------------------------------------
>From: "James Smeltzer" Sent: Friday, March 07, 2008 5:48 AM
>--------------------------------------------------
>--------------------------------------------------
>--------------------------------------------------
>To: "Multiple recipients of list ULTRASOUND"
>
>--
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>Subject: Ultrasound forum??! Help Me! Stir the pot!
>--------------------------------------------------
>
>--------------------------------------------------
>> This used to be a place I loved to go to. Things got very busy. Personal
>> issues intervened. Too many emails from someone hunting a job & Pfft?!
>> Resurrection!?
>>
>> Maybe this pot needs stirring!
>>
>> Hop y'all are doing NTs and nose bones at 10-14 weeks, and checking
>> cervixes at all 18 to 32 week studies!
>>
>> If not, then I would love to hear why not?
>>
>> Is anybody back there?!
>>
>> ;^) Jim S
>>
>> James S. Smeltzer, MD, FACOG, SMFM
>> Consultant, Maternal Fetal Medicine
>> Wellstar Physicians' Group
>> Northwest Women's Care
>> 787 Campbell Hill St
>> Marietta GA 30060
>> James.Smeltzer@wellstar.org
>> VM 678-290-3035
>> Off 770-528-0260
>> Page 404-318-3451
>>
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--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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