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PubMed2006

NIS vs SAGES: a comparison of national and voluntary databases.

BACKGROUND: Surgical outcomes are increasingly examined in an effort to improve quality and reduce medical error. The Nationwide Inpatient Sample (NIS) is a retrospective, claims-derived and population-based database and the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Outcomes Project is a prospective, voluntary and specialty surgeon database. We hypothesized that these two sources of outcome data would differ in regard to a single, commonly performed procedure. METHODS: Both the NIS, a national sample of all nonfederal hospital discharges, and the gastroesophageal reflux disease log of the SAGES Outcomes Project were queried for all fundoplications performed between 1999 and 2001 using either ICD-9 procedure code 44.66 or CPT codes 43280 or 43324. Patients with an emergency admission, age <17 years, and/or diagnoses for either esophageal cancer or achalasia were excluded. Both demographic and outcome variables were compared by either t-test or chi-square analysis, with a p value of <0.05 as significant. RESULTS: Both data sets were comparable for age and gender; however, the SAGES group had a higher rate of teaching hospital affiliation (71 vs 48%, p < 0.001). SAGES fundoplications had a consistently higher rate of comorbidities, including Barrett's esophagus (2.3 vs 1.1%, p = 0.005). The NIS fundoplications had a clear trend toward more associated procedures, including cholecystectomy (7.2 vs 2%, p < 0.001). Complication rates for the NIS data set were higher, including pulmonary complications (1.7 vs 0.5%, p = 0.03). No statistically significant differences existed between the two data sets for either length of stay or mortality. CONCLUSIONS: The two databases indicate that fundoplication is an operation with low morbidity and mortality. The SAGES Outcomes Project demonstrated that participating surgeons had a higher affiliation with teaching hospitals, higher reporting of comorbidity, and lower associated procedures than the NIS. Despite having more comorbidity and technical difficulty, patients from the SAGES Outcomes Project had equivalent or lower complication rates.

Databases, Factual↗

PubMed2005

New coding and billing opportunities for 2005--Part I.

Part I of this series will highlight several changes in coding and billing for 2005. Medicare has established new preventive medicine services and screening tests for beneficiaries, but they have certain qualifications and documentation rules that must be followed. New codes have been established for using the Internet or similar electronic communications in response to a patient's request. There are additional revisions for pediatricians, orthopedists, endoscopists and surgeons performing transplants and bariatric surgery. All new CPT codes must be activated and deleted codes must be discontinued effective January 1, 2005. From that date forward, the patient's date of service must reflect current diagnosis (ICD-9) and procedure/services (CPT and HCPCS) codes. The Health Insurance Portability and Accountability Act (HIPAA) mandated a January 1, 2005, date compliance for all new and deleted diagnosis (ICD-9-CM) and physician service codes (CPT and HCPCS). Physicians no longer are allowed the 90-day grace period to update their coding systems to reflect the changes. The new 2005 CPT book contains many revisions within the codes themselves along with revisions found in the specific "guidelines" at the beginning of many sections. The CPT codes for 2005 contain 26 deleted codes and 130 new codes, thus providing a challenge to update all coding systems by the January 1, 2005, compliance date for CPT codes.

Current Procedural Terminology↗

PubMed2006

Considerations in incorporating office-based ultrasound of the head and neck.

OBJECTIVE: The purpose of this study was to determine the cost considerations and strategies for incorporating ultrasound (US) in a head and neck practice. STUDY DESIGN AND SETTING: A retrospective chart review of office-based US procedures from 2001 to 2005 was completed at our academic medical center. Billing and coding for US and US guided fine needle aspiration (USFNA) were examined. RESULTS: The appropriate CPT codes are 76536 for US and 76942 and 10022 for USFNA-related procedures. The USFNA codes should be used repeatedly for correct coding of biopsies from multiple sites. Cost (equipment) sharing between specialties is a potential strategy for office-based US incorporation. CONCLUSION: Based on practice volume, specific CPT coding, and Medicare reimbursements, office-based US equipment and certification costs could be offset in 1 year. SIGNIFICANCE: Office-based US can be readily incorporated with significant benefits to patients. Billing and usage strategies were identified that would improve the economics of providing office-based US.

Biopsy, Fine-Needle↗

PubMedDate not supplied

Diagnosis and procedure coding for bone mass measurement.

OBJECTIVE: To provide background information and practical advice about coding for submission of claims for reimbursement for performing bone mass measurement studies. METHODS: The current procedural terminology (CPT) codes for diagnoses and procedures related to reduced bone mass and osteoporosis are reviewed, and Medicare and other payer policies are discussed. RESULTS: Although considerable differences exist in payer policies relative to bone mass measurement, notable consistency is developing for Medicare patients. The CPT codes for pertinent outpatient and inpatient services, and applicable CPT modifiers, are outlined. In addition, examples are provided of criteria imposed for qualification for coverage. If a carrier or payer is not expected to provide coverage for the performance of a bone mass measurement study, an advance beneficiary notice (waiver statement) should be processed and the patient should be informed about the potential responsibility for payment before the test is done. CONCLUSION: Osteoporosis is an important and costly disorder that is rapidly increasing in prevalence in our society. Clinical endocrinologists have a critical role in the management of patients with this condition and an opportunity to contribute to high-quality care. Proper selection of patients for assessment and treatment and an understanding of certain restrictions and necessary documentation for insurance coverage may help obtain reimbursement for their care.

Bone Density↗

PubMed2004

Application of the resource-based relative value scale system to pediatrics.

In today's rapidly changing health care environment, it is crucial to understand the genesis and principles behind the Medicare Resource-Based Relative Value Scale (RBRVS) physician fee schedule. Many third-party payers, including state Medicaid programs, BlueCross BlueShield, and managed care organizations, use variations of the Medicare RBRVS to determine physician reimbursement and capitation rates. Because the RBRVS fee schedule was created originally for Medicare only, pediatric-specific Current Procedural Terminology (CPT) codes and pediatric practice expense calculations were not included. The American Academy of Pediatrics supports the use of CPT codes and the RBRVS physician fee schedule and continues to work to rectify certain inequities of the RBRVS system as they pertain to pediatrics.

Forms and Records Control↗

PubMed2006

Regulatory changes that affect coding for immunotherapy.

BACKGROUND: During the past decade, a variety of federal regulations have had a significant impact on the way allergen immunotherapy is reimbursed and how Current Procedural Terminology (CPT) codes are used for this purpose. As mandated by the US Congress, the Centers for Medicare and Medicaid Services (CMS) through the Office of the Inspector General (OIG) targeted immunotherapy codes for scrutiny, because they are some of the most frequently used codes. OBJECTIVE: To examine how federal regulations have affected reimbursement for allergy immunotherapy and other allergy services. METHODS: A review was performed of the OIG survey of allergy immunotherapy and the OIG recommendations on CPT coding compliance guidelines. RESULTS: A preliminary survey found problems with medical appropriateness of allergen immunotherapy. For this reason, the OIG performed a more comprehensive study of 301 physicians using code 95165 to analyze by medical record and billing data whether the new billing rules were being correctly used and found that only 44% of physicians were following the new definition of a billable dose. In the early 1990s, the federal government served notice of its intent to more aggressively identify and prosecute health care providers who improperly billed and collected for medical services. Through the adoption of the 1991 US Sentencing Commission Guidelines, the government sought to enhance compliance by mandating lesser criminal penalties for violating organizations that nevertheless maintained and operated "effective compliance plans." In 2002, the OIG audited health care providers and recouped dollar 14.4 billion in improper payments by Medicare. Between January and June 2003, Medicare excluded 1,241 individual providers and health care entities due to fraudulent billing practices. CONCLUSIONS: Federal regulations have significantly affected reimbursement for allergy immunotherapy and other allergy services. Allergists need to be aware of these changes and implement the new recommendations into their practices.

Aged↗

PubMed2001

Immediate on-site interpretation of fine-needle aspiration smears: a cost and compensation analysis.

BACKGROUND: A significant body of literature exists supporting the cost effectiveness of fine-needle aspiration (FNA) cytology in the work-up of patients with potential neoplastic disease. Several authorities have stated that immediate, on-site smear evaluation by cytopathologists optimizes diagnostic accuracy and minimizes the technique's insufficiency rate. This favorable effect on FNA diagnostic accuracy is most pronounced for deep body sites, where FNA is guided by computed tomography (CT), ultrasound, bronchoscopy, or endoscopy. Little data exist regarding whether compensation from Medicare is adequate to support the pathologist in this endeavor compared with other potentially more remunerative activities, including routine surgical pathology sign-out, nongynecologic cytopathology sign-out, and frozen section consultation. METHODS: The authors studied a series of 142 fine-needle aspirates with immediate, on-site evaluations performed under a variety of clinical settings. These included bronchoscopic, endoscopic, ultrasound-guided, and CT-guided biopsies along with palpation-directed biopsies performed by either cytopathologists or clinicians. For these aspirates, total pathologist attendance time was calculated and correlated with guidance technique, target organ, location where aspirate was performed, and nature of aspirator. Fifty frozen section evaluations were timed similarly. For comparison purposes, cytopathologists' costs were calculated using the 80th percentile pay level of an associate professor with full-time clinical duties. Medicare rate schedules were used to calculate compensation. Including salary and benefits, the pathologist cost was approximately $88.83 per hour. RESULTS: On average, an intraprocedural FNA evaluation for a CT-guided biopsy required 48.7 minutes, an ultrasound-guided biopsy required 44.4 minutes of pathologist time, an endoscopic procedure required 56.2 minutes, a bronchoscopic procedure required 55.3 minutes, a clinic aspirate performed by a pathologist required 42.5 minutes, and a clinic FNA performed by a clinician required 34.7 minutes. The average frozen section required 15.7 minutes of pathologist time for performance and interpretation. With the exception of FNA performed in clinic by the cytopathologist, time costs exceeded compensation by $40-50 per procedure. Clinic aspirates performed by a clinician and immediately evaluated by a pathologist resulted in a deficit of approximately $18 over actual time cost. CONCLUSIONS: From the current data, it appears that intraprocedural consultations by cytopathologists for CT-guided, ultrasound-guided, bronchoscopic, or endoscopic procedures are compensated insufficiently by current Medicare compensation schedules using the CPT code 88172 for on-site evaluation. Only when the cytopathologist personally performs the aspirate and immediately interprets it (CPT codes 88172 and 88170) does the Medicare payment adequately compensate for professional services.

Biopsy, Needle↗

PubMedDate not supplied

Effect of postoperative epidural analgesia on morbidity and mortality after total hip replacement surgery in medicare patients.

BACKGROUND AND OBJECTIVES: The effect of postoperative epidural analgesia (vs. systemic analgesia) on patient outcomes is unclear. Available randomized controlled trials (RCTs) have focused on the intraoperative period and not properly examined the effect of postoperative epidural analgesia (EA) on outcomes. METHODS: A 5% nationally random sample of Medicare beneficiaries from 1994 to 1999 was analyzed to identify patients undergoing total hip arthroplasty (Common Procedural Terminology [CPT] code 27130, 27132, 27134, 27137, 27138). Patients were divided into 2 groups depending on the presence or absence of postoperative EA based on the CPT coding (01996). The rate of major morbidity (acute myocardial infarction, deep venous thrombosis, pulmonary embolism, angina, respiratory failure, heart failure, cardiac dysrhythmias, pneumonia, pulmonary edema, sepsis, acute renal failure, paralytic ileus, acute cerebrovascular event) and death at 7 and 30 days after the procedure were compared. Multivariate regression analysis was performed to determine if the presence of postoperative (EA) had an independent effect on mortality or major morbidity. Data were reported as an odds ratio with 95% confidence intervals (CI) when appropriate. RESULTS: The unadjusted 7- and 30-day death rate was significantly lower for EA versus no EA (1.9/1000 [95% CI: 0.2-3.6] vs. 3.9/1000 [95% CI: 3.0-6.2] at 7 days [P =.04] and 5.8/1000 [95% CI: 2.9-8.7] vs. 9.9/1000 [95% CI: 8.6-11.3] at 30 days [P = 0.01]). However, multivariate regression analysis revealed that there was no difference between the groups with regard to mortality or major morbidity with the exception of an increase in deep venous thrombosis in patients who received EA. CONCLUSIONS: The use of postoperative EA was not associated a lower incidence of mortality and major morbidity in Medicare patients undergoing total hip arthroplasty. However, the results should be interpreted with caution because of limitations in using the Medicare claims data for analysis. Further trials using other properly conducted and designed studies (e.g., RCTs) would be ideal to validate these results.

Aged↗

PubMed2007

Basic terminology in obtaining reimbursement for pharmacists' cognitive services.

PURPOSE: A basic overview and definitions of commonly used billing and reimbursement terminology that pharmacists will need to know to obtain reimbursement for cognitive services are provided. SUMMARY: Currently, the profession of pharmacy has been gathering momentum in its efforts to seek and obtain reimbursement for cognitive services. However, there have been major barriers in seeking reimbursement, including the lack of understanding by third-party payers of the pharmacist's role in patient care and the pharmacist's in-depth knowledge of pharmacotherapy, the lack of appropriate billing codes for pharmacists' services, and the lack of detailed knowledge and understanding by pharmacy practitioners of nondistributive reimbursement mechanisms, processes, and terminology. The types of services provided are usually described by the American Medical Association's Current Procedural Terminology (CPT) codes for the face-to-face provision of patient care services by a pharmacist. As of January 1, 2006, pharmacists have been able to indicate the appropriate diagnosis code from the International Classification of Diseases, 9th Revision (ICD-9) (ICD-10 will replace the ICD-9 on October 1, 2007), and CPT code when billing under a major medical plan that recognizes the pharmacist as a patient care service provider. Understanding the billing and reimbursement terminology will aid pharmacist communication with third-party payers, Medicare, and Medicaid. A glossary of the most commonly encountered terms in billing and reimbursement procedures for cognitive services is provided. Also included are lists of Web-based reimbursement resources and references on reimbursement for cognitive services by the pharmacist. CONCLUSION: An understanding of terminology is important in receiving reimbursement for cognitive services.

Drug Therapy↗

PubMed2006

Catheter use is high even among hemodialysis patients with a fistula or graft.

At any given time, approximately 27% of patients in the United States (US) receive hemodialysis through a permanent catheter. However, this cross-sectional estimate may significantly underestimate the lifetime exposure of patients to hemodialysis catheters, and hence, to the excess risk of the adverse clinical events associated with catheter use. To further clarify catheter use in hemodialysis patients, we identified a cohort of fistula and graft patients in the US Renal Data System using Current Procedural Terminology (CPT) codes. Patients were included if their first hemodialysis was between 1 January 1996 and 31 December 2001, and Medicare was their primary payer. We identified permanent catheter insertions in these patients using CPT codes starting 6 months before their first hemodialysis session (or fistula or graft placement, if earlier), and ending 40 months afterward. Most patients (82%) were >65 years old, 57% were male, and 72% were white. The overall rate of permanent catheter insertions was 44 per 100 patient years, with 57% of patients having at least one catheter insertion. The percent of patients receiving a catheter was similar before (30%) and after (27%) the first fistula or graft placement. Cross-sectional analysis may significantly underestimate the lifetime risk of exposure to hemodialysis catheters. Because catheter use is common even in fistula and graft patients, measures used to prevent adverse events associated with catheter use are important in all patients regardless of current access type.

Aged↗

PubMed2000

Recent developments in evaluation and management services.

Evaluation and management services are important aspects of interventional pain management; however, significant confusion continues as to proper coding and documentation in this field. In addition, recent developments in the area of evaluation and management services over the last few months are of significance to interventional pain physicians. Two major developments in the year 2000 include a warning from the Health Care Financing Administration (HCFA) with regards to misused codes, and issue of new draft evaluation and management guidelines to improve physician acceptance by simplification. The HCFA has sent letters to all physicians in the United States on June 1, 2000, with information that it will be focusing this year on two current procedural terminology (CPT) codes used to report evaluation and management services - 99214 and 99233. The HCFA contends that these codes accounted for a significant portion of coding errors in the last two audits and that documentation for many of these services was found to be sufficient only to support services more appropriately described by CPT codes 99212 and 99231 resulting in downcoding by two levels by HCFA and implying that physicians are upcoding by two levels. The second issue relates to the release of yet another version of the new draft evaluation and management guidelines by HCFA in June 2000. These were preceded by an article by the administrator of HCFA, Nancy-Ann Min DeParle, which was published in JAMA. The new guidelines are purported to eliminate "bullets" and "shading"; reduce the need for counting the "elements"; introduce the first specialty-specific vignettes; and include a nationwide study of the new proposed guidelines.

Journal Article↗

PubMed1995

A comparison of nursing intervention classification and current procedural terminology codes for representing nursing interventions in HIV disease.

The purpose of this study was twofold: 1) to compare the ability of terms from the nursing intervention classification and from the current procedural terminology to represent the clinical terms used by nurses and patients to describe nursing interventions during hospitalization; and 2) to identify the strengths and weaknesses of the two classification systems for representing nursing systems. More NIC than CPT codes matched the concepts in the clinical terms used by nurses and patients to describe nursing interventions demonstrating, not unexpectedly, that NIC represents a broader scope of nursing practice. The major difficulty encountered using NIC was the lack of mutual exclusiveness of the nursing activities within the interventions. CPT codes were easy to apply to the clinical terms, but were limited in scope for nursing practice. The findings of this study demonstrate the necessity of using a nursing-specific classification system for the representation of nursing interventions. This is of particular importance for databases that will be used to examine the effectiveness of healthcare interventions and for databases related to reimbursement for healthcare interventions.

Databases, Factual↗

PubMed2003

Percutaneous abscess drainage: use of related radiology services and associated economic impact on a radiology practice.

PURPOSE: To evaluate the impact of percutaneous abscess drainage on the usage and professional value of subsequent services provided by a radiology practice. MATERIALS AND METHODS: Percutaneous abscess drainage was selected as a marker interventional radiology procedure because of its pervasiveness and ease of identification of related services. Billing records were reviewed for 48 consecutive patients who underwent abscess drainage during a 9-month period. Current procedural terminology (CPT) codes for all radiology services during the subsequent 90 days were analyzed to identify those related to the initial drainage procedure. Professional relative value unit (RVU) impact was calculated. RESULTS: Initial abscess drainage services were identified by 2.6 +/- 1.2 CPT codes, but patients underwent 13.4 +/- 10.7 related radiology services during the subsequent 90 days. The professional RVU impact of subsequent services was 64% higher than that of initial procedures: initial drainage services accounted for 11.5 +/- 5.1 RVUs and all subsequent related radiology services accounted for 18.9 +/- 16.8 RVUs (P =.0042). Of those, additional interventional radiology procedures amounted to 10.7 +/- 12.8 RVUs, diagnostic radiology services 4.7 +/- 4.6 RVUs, and evaluation and management services 3.5 +/- 2.9 RVUs. CONCLUSION: Basic interventional radiology services may result in far more economic impact on radiology practices than initial direct procedure analyses suggest. For percutaneous abscess drainage, the professional RVU impact of subsequent services exceeds that of the initial procedure by 64%. Practices negotiating capitated contracts for interventional services need to consider the high value of such related services.

Abdominal Abscess↗

PubMed2005

Prospective, blinded evaluation of accuracy of operative reports dictated by surgical residents.

Incomplete or inaccurate operative notes result in delayed, reduced, or denied reimbursement. Deficient reports may be more common when dictated by the surgical residents. We performed a blinded study to assess the accuracy of residents' dictations and their effect on the appropriate level of coding for reimbursement. A prospective, blinded study was performed comparing operative reports dictated by senior surgical residents (postgraduate years 3, 4, and 5) to reports dictated by attending surgeons. All residents had previously undergone group instruction on the importance and structure of operative notes. The trainees were blinded to the fact that the attending surgeons were dictating the operative reports on a separate dictation system. The dictations were analyzed by faculty reimbursement billing personnel for accuracy and completeness. Fifty operative reports of general surgical procedures dictated by both surgical residents and attending physicians were reviewed. A total of 97 CPT codes were used to report services rendered. Residents' dictations resulted in incorrect coding in 14 cases (28% error rate). The types of inaccuracies were a completely missed procedure (4) and insufficient documentation for an appropriate CPT code and/or modifier (10). All deficiencies occurred in complex, multicode, and/or laparoscopic cases. Sixty-seven per cent of late dictations were incomplete. The financial analysis revealed that deficiencies in resident dictations would have reduced the reimbursement by $18,200 (9.7%). For cases with deficient dictations, 29.5 per cent of charges would have been missed, delayed, or denied if the resident-dictated note was used to justify charges. Operative reports dictated by surgical residents are often incomplete or inaccurate, likely leading to reduced or delayed reimbursement. Dictations of complex, multicode, or laparoscopic surgeries, especially if delayed beyond 24 hours, are likely to contain significant deficiencies that affect billing. Attending surgeons may be better equipped to dictate complex cases. Formal housestaff education, mentorship by the attending faculty, and ongoing quality control may be paramount to minimize documentation errors to ensure appropriate coding for the services rendered.

Current Procedural Terminology↗

PubMed1994

Coding and reimbursement issues for dual-energy X-ray absorptiometry.

Bone densitometry has a unique and invaluable place in the prevention, diagnosis, and management of osteoporosis. Dual-energy X-ray absorptiometry (DEXA) is currently considered the bone densitometric technique of choice. With this method, the patient at risk for osteoporosis can be identified so that appropriate clinical interventions to prevent fracture can be undertaken. DEXA also allows assessment of the efficacy of these interventions in preventing bone loss. As with any other technology, however, bone densitometry must be properly used in the clinical setting to achieve this benefit. Critical to the proper use of the technology is the realization that a complete assessment of fracture risk requires the measurement of both the spine and the proximal part of the femur, not either site alone, and that assessment of therapeutic efficacy might also require the measurement of both sites, not either site alone. Effective January 1, 1994, the Clinical Procedural Terminology (CPT) code for DEXA has been 76075. This code is intended for measurement of a single site and is to be reimbursed at a global rate of $60.85. Although the assignment of a CPT code for this clinically valuable technology is most welcome, the lack of a code reflecting at least two sites of study and the low rate of reimbursement for a single site suggest a misunderstanding of the actual costs of the technology and the need, on occasion, for measurements at multiple sites.

Absorptiometry, Photon↗

PubMed2001

Medicaid and Medicare reimbursement for flow cytometry.

Medicaid, a program administered by individual states but involving federal funding, is the source of medical coverage for many low-income patients. This method of reimbursement is crucial for many flow cytometry laboratories, but is not well understood by many laboratory professionals. Conversely, flow cytometry often is not well understood by administrators in Medicaid offices. The potential exists for great variation in Medicaid reimbursement for flow cytometry services from state to state. As a first step toward elucidating the extent of this variation and bringing more information about Medicaid to laboratory professionals, state Medicaid offices were asked to provide the fee-for-service reimbursement for flow cytometry services. These services included Current Procedural Terminology (CPT) codes 85045 (reticulocyte counts), 86359 (total T-cell count), 86360 (absolute CD4 and CD8 counts, with ratio), 86361 (absolute CD4 count), 86812 (HLA typing, single antigen [B27]), 88180 (immunophenotyping, per surface marker), and 88182 (DNA, cell cycle analysis). Data were collected on technical and professional components and on global reimbursement. Wide variation exists in reimbursement amounts for these tests. Variation for CPT code 88180 was markedly pronounced.

Diagnostic Services↗

PubMed2006

The Soterion Rapid Triage System: evaluation of inter-rater reliability and validity.

The Soterion Rapid Triage System is a new, computerized, five-level triage acuity system. The purpose of this study was to evaluate the system's inter-rater reliability and validity for stratifying patient acuity. The study was comprised of two components. A prospective evaluation of inter-rater reliability was conducted by the blinded, paired simultaneous triage of 423 patients. A retrospective evaluation of validity consisted of the analysis of 33,850 patients triaged with the system over an 8-month period. The system's validity was measured by in-hospital admission rate, Emergency Department (ED) length-of-stay, hospital charges and Current Procedural Terminology (CPT) Codes 99281-99285. Evaluation of inter-rater reliability demonstrated a weighted kappa of 0.87 (95% confidence interval 0.84, 0.91). The in-hospital admission rates for patients triaged as Level 1 Immediate-Level 5 Non-Urgent were 43%, 30%, 13%, 3% and 1%, respectively (p < 0.0001). Similarly, there were significant differences in the means for all hospital charges, ED lengths-of-stay, and CPT Codes. In conclusion, the Soterion Rapid Triage System possesses high inter-rater reliability and validity. The system's reliability and validity, and the availability of the system's electronically archived data are characteristics beneficial to the development of a national standardized five-level triage acuity system.

Algorithms↗

PubMed2000

1999 ASGE endoscopic ultrasound survey. ASGE Ad Hoc Endoscopic Ultrasound Committee.

BACKGROUND: Gastrointestinal endoscopic ultrasound (EUS) has become an important imaging modality for the diagnosis and staging of gastrointestinal disorders. This study assessed current EUS practice, training, coding, and reimbursement in the United States. METHODS: A direct mail survey was sent to members of the American Society for Gastrointestinal Endoscopy. RESULTS: There were 115 American respondents. The median age was 39 years, 57% were in academic practice, and 84% performed endoscopic retrograde cholangiopancreatography. The median number of EUS procedures performed was 200. In the preceding year, the median number of upper EUS was 60, lower EUS 10, and EUS/fine-needle aspiration 3. The most common indication was evaluation of esophageal or gastric lesions. Forty-six (40%) trained an average of 0.4 advanced fellows in EUS during the prior year. Of endosonographers involved in training, 53% thought formal training was necessary, for a median of 6 months and 100 procedures; 82% did not know whether they were reimbursed for EUS. There was great variation in the use of current procedural terminology (CPT) codes for lower EUS and upper EUS/fine-needle aspiration. CONCLUSIONS: EUS in the United States in 1999 is performed mostly by young, academic, interventional endoscopists. Diagnostic upper EUS is most commonly performed. Few new endosonographers are being trained. There is great variability in CPT coding of lower EUS and EUS/fine-needle aspiration procedures.

Adult↗