Essentials of Point-of-Care Ultrasound Coding and Billing at the Neonatal Intensive Care Unit Setting in the United States

Abstract

Point-of-care ultrasound (POCUS) has increasingly been used by neonatal providers in neonatal intensive care units in the United States. However, there is a lack of literature addressing the complexities of POCUS coding and billing practices in the United States. This article describes the coding terminology and billing process especially those relevant to neonatal POCUS. We elucidate considerations for neonatal POCUS billing framework and workflow integration. Directions on image storage and supporting documentation to facilitate efficient reimbursement, compliance with billing regulations, and appeal to insurance claim denial are discussed.

Key Points

• Code neonatal POCUS procedure precisely allows accurate reimbursement and reduced errors in billing.

• Document details to support medical necessity and reimbursement claims effectively.

• Adhere to regulations to avoid audits, denials, and ensure proper reimbursement.

Keywords

neonate - point-of-care ultrasound - billing - reimbursement - ICD codes - CPT Codes

Authors' Contributions

B.C. and Y.S. contributed equally to the concept design, research, writing, and editing of the manuscript. The others contributed to the editing of the manuscript.

Publication History

Received: 22 February 2024

Accepted: 28 March 2024

Article published online:
02 May 2024

• References

• 1 Singh Y, Tissot C, Fraga MV. et al. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020; 24 (01) 65
• 2 Stewart DL, Elsayed Y, Fraga MV, Coley BD, Annam A, Milla SS. The Committee on Fetus and Newborn and Section on Radiology, Section on Radiology Executive Committee, 2021–2022. Use of point-of-care ultrasonography in the NICU for diagnostic and procedural purposes. Pediatrics 2022; 150 (06) e2022060053
• 3 Stewart DL, Elsayed Y, Fraga MV, Coley BD, Annam A, Milla SS. Committee on Fetus and Newborn and Section on Radiology, Section on Radiology Executive Committee, 2021–2022. Use of point-of-care ultrasonography in the NICU for diagnostic and procedural purposes. Pediatrics 2022; 150 (06) e2022060052
• 4 Adhikari S, Amini R, Stolz L. et al. Implementation of a novel point-of-care ultrasound billing and reimbursement program: fiscal impact. Am J Emerg Med 2014; 32 (06) 592-595
• 5 American College of Emergency Physicians. Ultrasound guidelines: emergency, point-of-care, and clinical ultrasound guidelines in medicine. [Internet]. 2016 : emergency ultrasound section. Accessed June 5, 2017 at: https://www.acep.org/Clinical—Practice-Management/Ultrasound/#sm.0001wi32c84dcew4yrs2erxapx6h1
• 6 Lewiss RE, Cook J, Sauler A. et al. A workflow task force affects emergency physician compliance for point-of-care ultrasound documentation and billing. Crit Ultrasound J 2016; 8 (01) 5
• 7 Hughes D, Corrado MM, Mynatt I. et al. Billing I-AIM: a novel framework for ultrasound billing. Ultrasound J 2020; 12 (01) 8
• 8 Wu S, Guttman J. Coding and reimbursement. [Internet]. 2023 ACEP EUS Coding and Reimbursement Update. [cited] Accessed August 1, 2023 at: https://www.acep.org/emultrasound/subcommittees/coding-reimbursement
• 9 Koenig SJ, Lou BX, Moskowitz Y, Narasimhan M, Mayo PH. Ultrasound billing for intensivists. Chest 2019; 156 (04) 792-801
• 10 Bronshteyn YS, Blitz J, Hashmi N, Krishnan S. Logistics of perioperative diagnostic point-of-care ultrasound: nomenclature, scope of practice, training, credentialing/privileging, and billing. Int Anesthesiol Clin 2022; 60 (03) 1-7
• 11 AMA. ICD-10-CM 2020 the Complete Official Codebook. American Medical Association; 2019
• 12 AAP. Coding for Pediatrics 2023: A manual for pediatric documentation and Payment – American Academy of Pediatrics Committee on Coding Nomenclature. American Academy of Pediatrics; 2023
• 13 AMA. CPT professional 2023–American Medical Association. American Medical Association; 2022
• 14 Duncan SD, Martin GI, Pearlman SA. AAP. Quick Reference guide to neonatal Coding and Documentation. 2nd ed.. American Academy of Pediatrics; 2016
• 15 Lakshminrusimha S, Song C, Pearlman SA, Martin G, Duncan S. Controversies in CPT® coding in the neonatal intensive care unit: - critical vs. intensive care. J Perinatol 2023; 43 (12) 1535-1540
• 16 Blue Cross Blue Shield. [Internet]. Pediatric and neonatal critical care services and intensive (non-critical) care services. Accessed January 1, 2024 at: https://providers.bcbsal.org/portal/resources/-/resource/viewArticle/JB7LD7314I
• 17 Nemerofsky SL, Silver EJ, Liechty EA, Pearlman SA, Campbell D. Factors associated with neonatal coding knowledge: results of a national survey. J Perinatol 2022; 42 (10) 1415-1416
• 18 American College of Emergency Physicians. [Internet]. Templated letters for appealing denied claims. [cited]. Accessed January 7, 2024 at: https://www.acep.org/administration/reimbursement/templated-letters-for-appealing-denied-claims/templated-letters-for-appealing-denied-claims
• 19 Flannigan MJ, Adhikari S. Point-of-care ultrasound work flow innovation: impact on documentation and billing. J Ultrasound Med 2017; 36 (12) 2467-2474 DOI: 10.1002/jum.14284.
• 20 Rong K, Chimileski B, Kaloudis P, Herbst MK. Impact of an epic-integrated point-of-care ultrasound workflow on ultrasound performance, compliance, and potential revenue. Am J Emerg Med 2021; 49: 233-239
• 21 Thompson B, Schoenfeld E, Westafer L, Visintainer P, Budhram G. Implementation of an automated, user-centered point-of-care ultrasound workflow improves documentation and billing. Acad Emerg Med 2023; 30 (03) 180-186
• 22 Saati A, Au A, Chu T. et al. Creating an efficient point-of-care ultrasound workflow. POCUS J 2020; 5 (02) 31-32