Ultrasound use in ICU/CCU These guidelines have been developed to assist with reporting ultrasound services performed in the hospital ICU and CCU settings. SonoSite provides this information as a courtesy to assist providers in determining appropriate codes and other information for reimbursement purposes. It is the provider's responsibility to determine and submit appropriate codes, modifiers, and claims for services rendered. SonoSite makes no guarantees concerning reimbursement or coverage. Please feel free to contact the SonoSite reimbursement staff if you have any questions at 1-888-482-9449.

Ultrasound services in ICU/CCU are typically considered to be covered services as long as medical necessity is properly established and supported by documentation. While ultrasound services are not considered primary procedures and, therefore, do not determine the Medicare DRG assignment, it is still important for physicians to document the performance of these procedures in the patient's record and for the hospital to assign an ICD-10 procedure code for the purposes of determining the standardized charge and evaluating the discharge for outlier payment status.

Please note the following with regard to hospital billing of ultrasound procedure codes in the ICU/CCU settings:

• When performing procedures where ultrasonic guidance is used, a separate guidance code does not exist for reporting hospital services. Rather, it is considered included in the primary procedure being performed.

• While not all inclusive a list of viable ICD-10 codes are attached for reference on page 2-3.

Code Selection The following revenue code is used to report the facility portion of ultrasound services in the ICU/CCU setting.

Revenue Code Descriptor 402 Other imaging services, ultrasound

Coding and Payment Information Physicians report the professional component of ultrasound services by appending the -26 modifier to the CPT1 code on the CMS 1500 billing form. The following payment information is based on the unadjusted Medicare physician fee schedule and reflects the reimbursement for the physician's service. The actual payment will vary by location.

CPT Code Descriptor Medicare Physician Fee Schedule

- National Average* Professional Payment

75989 Radiological guidance (ie, fluoroscopy, ultrasound or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation

$59.47

76604 Ultrasound, chest, real time with image documentation $27.59 76705 Ultrasound, abdominal, real time with image documentation; limited $30.10

76775 Ultrasound, retroperitoneal (e.g., renal, aorta, nodes), real time with image documentation; limited $29.38

76930 Ultrasonic guidance for pericardiocentesis, imaging supervision and interpretation $33.32

+ 76937

Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, docu mentation of selected vessel patency, concurrent real-time ultrasound visualization of vascular needle entry, with permanent recording and reporting

$14.69

76942 Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation $34.04

January 2016UltrasoundReimbursement Information

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Coding and Payment Information continued

CPT Code Descriptor Medicare Physician Fee Schedule

- National Average* Professional Payment

93303 Transthoracic echocardiography for congenital cardiac anomalies; complete $64.85

93304 Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study $37.26

93306 Echocardiography, transthoracic, real time with image documentation (2D) includes M-mode recording when performed; complete, with spectral Doppler and color flow Doppler.

$64.49

93307 Echocardiography, transthoracic, real time with image documentation (2D) includes M-mode recording when performed; complete, without spectral Doppler or color flow Doppler.

$45.86

93308 Echocardiography, transthoracic, real-time with image documentation (2D) includes M-mode recording when performed; follow-up or limited study $26.15

93312 Echocardiography, transesophageal, real time with image documentation (2D) with or without M-mode recording; including probe placement, image acquisition, interpretation and report

$123.61

93313 Echocardiography, transesophageal, real time with image documentation (2D) with or without M-mode recording; placement of transesophageal probe only $22.88

93314 Echocardiography, transesophageal, real time with image documentation (2D) with or without M-mode recording; image acquisition, interpretation and report only $100.11

+ 93320 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; complete $18.63

+ 93321 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; follow-up or limited study $7.52

+ 93325 Doppler echocardiography color flow velocity mapping $3.22

93971 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study $22.93

ICD-10 categories for use in the ICU

Categories Potential ICD-10-CM

Descriptor

Abdomen and retroperitoneum

BW40ZZZ Ultrasonography of Abdomen

Digestive system BD47ZZZ Ultrasonography of Gastrointestinal Tract BF40ZZZ Ultrasonography of Bile Ducts BF43ZZZ Ultrasonography of Gallbladder and Bile Ducts BF4CZZZ Ultrasonography of Hepatobiliary System, All

Head and neck BH4CZZZ Ultrasonography of Head and Neck Heart B244YZZ Ultrasonography of Right Heart using Other Contrast

B244ZZ4l Ultrasonography of Right Heart, Transesophageal B244ZZZ Ultrasonography of Right Heart B245YZZ Ultrasonography of Left Heart using Other Contrast B245ZZ4 Ultrasonography of Left Heart, Transesophageal B245ZZZ5 Ultrasonography of Left Heart B246YZZ Ultrasonography of Right and Left Heart using Other Contrast B246ZZ4 Ultrasonography of Right and Left Heart, Transesophageal B246ZZZ Ultrasonography of Right and Left Heart B24DZZ4 Ultrasonography of Pediatric Heart, Transesophageal B24DZZZ Ultrasonography of Pediatric Heart

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ICD-10 categories for use in the ICU continued

Categories Approximate ICD-10-CM

Descriptor

Other diagnostic BU4CZZZ Ultrasonography of Uterus and Ovaries BV49ZZZ Ultrasonography of Prostate and Seminal Vesicles BW41ZZZ Ultrasonography of Abdomen and Pelvis Peripheral vascular system

B34HZZZ Ultrasonography of Right Upper Extremity Arteries B34JZZZ Ultrasonography of Left Upper Extremity Arteries B34KZZZ Ultrasonography of Bilateral Upper Extremity Arteries B44FZZZ Ultrasonography of Right Lower Extremity Arteries B44GZZZ Ultrasonography of Left Lower Extremity Arteries B44HZZZ Ultrasonography of Bilateral Lower Extremity Arteries B54BZZZ Ultrasonography of Right Lower Extremity Veins B54CZZZ Ultrasonography of Left Lower Extremity Veins B54DZZZ Ultrasonography of Bilateral Lower Extremity Veins B54MZZZ Ultrasonography of Right Upper Extremity Veins B54NZZZ Ultrasonography of Left Upper Extremity Veins B54PZZZ Ultrasonography of Bilateral Upper Extremity Veins

Thorax B340ZZZ Ultrasonography of Thoracic Aorta BB4BZZZ Ultrasonography of Pleura BB4CZZZ Ultrasonography of Mediastinum BH40ZZZ Ultrasonography of Right Breast BH41ZZZ Ultrasonography of Left Breast BH42ZZZ Ultrasonography of Bilateral Breasts

Urinary system BT40ZZZ Ultrasonography of Bladder BT41ZZZ Ultrasonography of Right Kidney BT42ZZZ Ultrasonography of Left Kidney BT43ZZZ Ultrasonography of Bilateral Kidneys BT45ZZZ Ultrasonography of Urethra BT46ZZZ Ultrasonography of Right Ureter BT47ZZZ Ultrasonography of Left Ureter BT48ZZZ Ultrasonography of Bilateral Ureters BT4JZZZ Ultrasonography of Kidneys and Bladder

CPT® five digit codes, nomenclature and other data are Copyright 2015 American Medical Association. All rights reserved. No fee schedule, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

*Federal Register November, 2015. Reimbursement rates shown for payment of services under the Physicians Fee Schedule reflect a conversion factor of $35.8279.

The information in this handout is intended to assist providers in determining appropriate codes and the other information for reimbursement purposes. It represents the information available to SonoSite as of the date listed above. Subsequent guidance might alter the information provided. SonoSite disclaims any responsibility to update the information provided. The only persons authorized by SonoSite to supply information regarding any reimbursement matter not reflected in a circular such as this are members of SonoSite's reimbursement staff.

It is the provider's responsibility to determine and submit appropriate codes, modifiers, and claims for the services rendered. Before filing any claims, providers should verify current requirements and policies with the applicable payer. SonoSite makes no guarantees concerning reimbursement or coverage. A provider should not rely on any information provided by SonoSite in submitting any claim for payment, without confirming that information with an authoritative source.

1Current Procedural Terminology (CPT®) Copyriht 2015 American Medical Association

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