ED Coding and Reimbursement Alert

Question: One of our ED physicians has been doing ultrasounds on trauma patients. He said it is called FAST (Focused Assessment with Sonography for Trauma) and wants to know how to charge for it. Its a combination of abbreviated ultrasound exams to the abdomen, liver, spleen, pelvis and pericardium. Do you have any information about this?

Ohio Subscriber

Answer: Many physicians are doing FAST exams on a research-only basis and are not billing for them. However, this procedure is being done in many centers, so its use will increase dramatically in the next couple of years.

As there is no specific code for this service, it appears the only way to charge for FAST is by using the radiology codes, with modifier -26 (professional component). The most appropriate code to use for FAST is 76705 (echography, abdominal, B-scan and/or real time with image documentation; limited [e.g., single organ, quadrant, follow-up]). It may mean even using a combination of codes requiring both the -52 (reduced services) and -26 modifiers (to equal modifier -99 [multiple modifiers]) as more areas are examined than are reflected by the 76705.

In addition to coding, there is a credentialing issue. Many hospital governing bodies feel that an individual doctor needs 40 hours of continuing medical education training and 150 proctored exams before being credentialed for FAST.