1. Jamie Jenkins MD FHS Regional Ultrasound Director

2.  “I just want to answer the question I have and move on.”  “ I don’t think the patient should be billed for this.”  “I promise not to make medical decisions based on my ultrasound.”  “My scribe is the one who checks all the boxes.”

3.  In order to answer the question properly with any imaging study, including a bedside ultrasound, you need properly acquired and correctly interpreted images.  Includes  Correct image acquisition (see ultrasound cards) Based on ACEP criteria  Documentation Limited US T-sheet  Ordering the scan ED US non-cardiac on ESR Storage in PACS

4.  Storage in PACS  All radiology images associated with patient care must be kept for 7 years.  Without an order, our images will only stay for 3 months.  Includes Central line images  Partial scans and incorrect documentation create a legal risk for providers, Team Health, and FHS.

5.  The reason an order needs to be placed is not only for billing but also to ensure storage on PACS  Billing fraud:  Billing for an incomplete scan is fraud  There are no TEAM health coders that review ultrasound billing to catch incorrect billing  QA process is the only way to detect billing fraud  If you perform a bedside US and order a comprehensive one the patient will only be billed for the latter.

6.  Not a possibility  You can not un-see what you have seen  Training scans (education/practice) are an exception to this rule so long as they are labeled as such and there is a back up comprehensive study if needed.  Training studies are protected under QI rules and are not discoverable.

7.  The provider is always the responsible party  The documentation is still yours if you sign it  It is your responsibility to check for accuracy  The scribes are aware

8.  Only 21% of EM physicians personally perform bedside ultrasound  Standard of Care: Central lines  No lawsuits for misreads as of 2007  3 lawsuits for failure to use  2 with AAA  1 with rule out ectopic  Credentialing  Can we hide behind it or with out it?

9.  Press new patient key in upper left hand corner of the keyboard

10. Non-credentialed physicians  Last name: Training  First name: EDUS  Do not fill out MR number  Operator: Your name  Press exit and start scanning

11.  Credentialed physicians only  Enter an order with the HUCs  Click worklist  Select patients name from list  The screen will self populate  Fill in your name under operator  Press exit and start scanning

12.  If you manually enter the patient information including the MR number  No leading zeros  No dashes  No FIN numbers  Ex: MR number is 001-234-567  Enter 1234567  Still need to enter an order after the fact

14.  Press the transducer key and then use the soft keys to select which transducer you need

16.  Document on central line section of the procedural T- sheet:  Wire or needle seen in lumen  Image saved to patients permanent record  You must save an image of this.

17.  50 scans to remain credentialed in all areas of ultrasound over 2 years  CME is required as well  This lecture  Scanning shifts with me  Ultrasound courses/lectures at conferences

18. ProviderNumber of scans in last year Stone22 Hubble3 Schlicher12 Willam25 Casey31 Lee26 Esterhay25 Yang25 Swenson13 Ward3 Gonzales5 Hile7 Husainy5 DeOlivera20