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US Guided Injecitions
It looks like the AMA and its CPT coding rules are out to reduce US guided injections in 2012 again. Next year they have excluded SI injections. Several others were excluded in 2011 (transitional codes were put in place that are largely non reimbursable and remain in effect for 2012).. This is despite a growing body of literature supporting the use of US Guided injections.
There seems to be a big disconnect between payment policy and published literature. Maybe we need to get AIUM to weigh in on the topic with the AMA.
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Replies to This Discussion
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Permalink Reply by Kate Zale on -
There is a disconnect...hopefully not always; also increasing is literature and CPT codes advancing msk for pediatric rheumatology.
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Permalink Reply by Balfor, George W. on -
clearly Ultrasound improves patient care and reduces risk at a low level of expense.
Diagnositic Ultrasound also saves money by reducing the numbers of more expensive studies being done
AIUM and other representive body groups need to make that point to AMA, and payers.
The arguement needs to be that this modality is more convenient for patients, saves patient and physicians time, and saves the 3rd party payors lots of money
This is a win win for everyone ( except perhaps owners of MRIs )
Once that arguement is made the cost pressures will lessen
If some one looks at the opposition to US it may well be coming from the radiologists to whom US could be perceived as an economic threat.
As always the point is follow the money and look at the source of a pressure.
George Balfour
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Permalink Reply by Syed Amir Gilani on -
Interesting
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Permalink Reply by Paul J Allen MD on -
Maybe another organization needs to develop codes outside of the AMA. Then market these codes to insurance companies as a better means of monitoring and paying for appropriate use of ultrasound.
This has to happen sometime or it is the AMA controlling coding forever.
Paul Allen
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Permalink Reply by Balfor, George W. on
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Fortunately or unfortunately the AMA committee does control this process. Codes only count if the payers recognize and accept them. Only the AMA can generate codes that are accepted as valid.
If the AIUM wants to protect the economic viability of Utrasound as a technology then it has to present evidence to the AMA to "protect" its turf. The committee looks at the costs in equipment and in time and attemmpts to generate values that reflect those costs.
Clearly if the codes are set too low providers will not have enough incentive to get into Ultrasound. That would not be in providers, payors or patients best interests. The lower associated costs of Ultrasound as compared to MR should be of interest to payors . The convenience of in office musculosketal ultrasound is of interest to patients . The rapidly availible information is of help to physicians.
It should be the responsiblity of AIUM to make that case.
One problem is that since AIUM is a multi specialty organization, and since this particular food fight pits to some degree musculoskeletal physicians against radiologists , AIUM might find itself caught in the middle.
The insurance industry is likely to take the short view and attempt to save money today at the expense of greater savings in the future. Unfortunately it is the American corporate business model to look only at the current quarter's bottom line, where as many foreign corporations take a longer view. Remember that the payers have a some say in the code values.
George Balfour
Van Nuys Ca
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Permalink Reply by robert g schwartz on -
I agree. By way of this forum I would like to make a formal request to the AIUM leadership to lobby, provide organizational support as required, and help the membership make the necessary case to the AMA to enhance coverage for US Guided spine related injections. This is to include, but not limit itself to, the establishment of permanent codes for the current transitional codes (examples include 0228T, 0230T) and removing language that requires severe downcoding coding of injections for codes such as 27096 to 20550 when done with US Guidance.
There is always politics involved, however I dont think the radiologists are the ones fighting this. Rather the biggest resistance (and it is decisive) comes from those who make their living using flouro.
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Permalink Reply by robert g schwartz on
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Pain Medicine News published in its Dec 2011 edition an article by Michael Gofeld, MD (U. Wash) wherein he cites that there is level 1 (conclusive) support of lumbar zygoapophysial joint injections, medial branch and dorsal ramus block.
AIUM needs to step up to the plate.
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Permalink Reply by Robin Hurni on -
I have been a Sonographer for 27 years. I was an IR tech prior. Mr. Schwartz nailed it..the biggest resistance is from the flouro Radiologists.
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Permalink Reply by robert g schwartz on
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So far no reply from AIUM....Will AIUM help its membership to communicate to the AMA that transitional codes need to be replaced with permanent codes or not? Also will it commnunicate to the AMA the full scope of accepted US guided spine, spine related, and hip injections or not?
The Am.J Phy. Med. Rehab. Vol 90, No. 10, Oct 2011, pages 860-867 has a ;ublished article on "Ultrasound -Guided Injection Techniques for the Low Back adn Hip Joint" where in Caudal Epidural Steroid injection, SacroIiaic Injection, Prirformis injection an dHip Joint injection are reviewed.
It will be easy to just keep posting references. there are many.
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Permalink Reply by robert g schwartz on
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OK , here are two more references (I'll consider these to for March!)..
US imaging facilitates spinal anesthesia in adults with difficult anatomic landmarks, Ki Jinn Chin et al,
Anesthesiology, C 115, no 1, pg 94, July 2011. This article documents the utility of US Guidance in Interlaminar Epiddural Steroid Injections. I t clearly documents the use of MSK US to visualize the vertebral bodies, articular processes, lamina, intrathecal and laminar space.
It also quotes: Ultrasound Imaging for Regional Anesthesia: A Practical Guide Booklet, Third edition, Ultrasound for Regional Anesthesia.
Did you know that Sonosite holds 15 courses a year on "Introduction to US Guidance For Regional Anesthesia"?
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Permalink Reply by AIUM on -
The appropriate channel for communicating this issue will be through the MSK Community meeting at the AIUM Annual Convention in Phoenix. The meeting is scheduled for Saturday, March 31 from 8:15am-9:45am. After discussion, if the community determines that a recommendation to the AIUM leadership is in the groups interest, a motion can be made and it will discussed at the Executive Committee level.
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Permalink Reply by Balfor, George W. on
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Not every one can get to this annual meeting . However on line forums are a great way to bring these issues to an associations leadership . I must disagree with who ever posted above . They should accept these posts as equal to standing up at the aium meeting . The leadership is herein put on notice that some of the membership want AIUM to take a more active role in economic issues such as relative values and the worth of US services
If US is severely under valved people will not provide the service
Already radiologist avoid. Msk us because it pays far less than mr
Geoge Balfour -
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