Wiki Ultrasound Billing Question

[jpeyron]

We are an ambulatory clinic with a mid-level provider that is also a licensed sonographer. Sometimes he will preform ultrasounds on our patients to help determine a diagnosis. The images are never forwarded to a radiologist so we do not have official radiology reports. How do we bill these scans (or should we be billing them at all?) Thanks!

 

[torresreb]

I used to work for a very large Medical Center in San Francisco, CA for 22 years and 11 of those years in Radiology. To give you some background on my answer;

OB Clinic would do an ultrasound on the patient and would 'read' the report with no issue. It was billed and services paid (of course as long as there was active coverage, diagnosis and CPT matched report etc).

Now when the OB would 'see' something that did not look appropriate she/he would then refer the patient to Radiology to get another US done and have it read out and diagnosed by a credentialed radiologist.

So to answer your question as long as the CPT supports the US done, the patient is fine with a non radiologist reading the scans and/or the physician refers when they are suppose to (medically indicated) then there is no issue.