First, the code should only be declared if the ultrasound is used with the “dynamic” technique, as opposed to the “static” technique, which is not considered a refundable service. Lanza et al (2021) compared the outcome of US-controlled percutaneous irrigation of rotator cuff calcium tendinopathy (US-PICT) in patients with or without prior external shock wave therapy. These researchers analyzed all patients treated with U.S. PICT from March 1, 2016 to October 1, 2019, with shoulder pain refractory to conservative management of calcined rotator cuff tendinopathy diagnosed in the United States. Each patient was screened before and after treatment with the Constant-Murley Score (CMS) questionnaire (score 0 to 100). These researchers tested the CMS differences using the Mann-Whitney U (Wilcoxon Rank-sum) test in the 2 groups. US-PICT was achieved by placing 2 or more 14G needles depending on the calcification size introduced under US guidelines to create an irrigation cycle in the calcified tendon. A solution of NaCl at 38°C was then injected from the input needle in varying amounts to hydrate and fragment the calcification, which eventually allowed its exit through the outlet needle. All patients also received an intrabursal injection of steroids. From 2016 to 2019, a total of 72 U.S. PICT treatments were performed on 70 patients (women = 46; Men = 26 years) with an average age of 49.7 years (SD = 8.7 years). 33 (47%) have had an ESD, while 37 (53%) had not received any previous treatment. No treatment-related complications were observed.
Follow-up lasted an average of 14.4 months (median 11.6, SD = 11.9, range 1 to 45); 37 patients had a follow-up period of less than 12 months (1 to 11.6); 35 patients were visited after more than one year (12.2 to 45.6). Prior to treatment, the average CMS was 35 (SD = 21); after treatment, it reached 75.4, with an average CMS improvement of 40.3 points (SD = 23.7, p < 0.001). Comparison of improvement between the ESWT and non-ESWT groups showed no significant difference (p = 0.3). The authors concluded that the American rotator cuff PICT is an effective procedure for reducing shoulder pain and increasing mobility in patients with calcium tendinopathy, both in the short and long term. Previously unsuccessful ESWTs have no effect on the outcome of the US-PICT. If these requirements are not met and/or a subsequent ultrasound is ordered to determine the diagnosis, the ultrasound will be considered part of the patient`s first assessment and management (C/M) examination and may be billed accordingly. In a prospective, randomized, triple-blind study, Fredrickson and Price (2009) tested the hypothesis that a continuous 48-hour infusion of C5-C6 root/upper trunk controlled by the 0.4% ropivacaine patient would provide superior analgesia after shoulder surgery compared to the same 0.2% deropivacaine infusion. Patients who presented for painful shoulder surgery were recruited. A perineural catheter was placed under ultrasound guidance (US) directly next to the C5-C6 roots/upper trunk. Ropivacaine 5 mg ml(-1) (30 ml) was administered via this catheter under general anesthesia prior to surgery. At the end of surgery, patients were randomized to receive 2 mg ml (-1) (0.2%) (n = 32) or 4 mg ml (-1) (0.4%) (n = 33) ropivacaine via an elastomer pump that delivered 2 ml of H(-1) with 5 ml of bolus controlled by the patient as needed.
Acetaminophen and diclofenac were administered for postoperative pain, ropivacaine bolus for a numerical pain score (NRPS, 0 to 10) greater than 2 and rescue trabamole for an NRPS greater than 3. All patients were called to postoperative days 1 and 2 and asked for evidence of treatment effectiveness and side effects. The NDS, the need for deropivacin patients, and additional tramadol use were similar in each group [median of “average daily pain days” 1/2 (0.2% = 1/3, 0.4% = 2/3)]. Episodes of an insensitive/densely clogged arm occurred with only 0.4% ropivacaine (5 episodes versus 0, p = 0.05). Satisfaction (numerical rating scale, 0 to 10) was 0.2% higher for ropivacaine (mean difference [MD] 1.3; 95% confidence interval [CI] 0.3 to 2.4; p = 0.01). The authors concluded that roricaine 0.2% at 2 ml h(-1) after major shoulder surgery with a 5 ml bolus administered via a US-guided C5-6 perineural catheter caused similar analgesia, but higher patient satisfaction compared to ropivacaine 0.4%. So I think this question has two tracks. There is an ultrasound to guide the musculoskeletal system and “quick looks” that may not be billable, and another to perform more “real” ultrasounds. Magazzeni et al (2018) found that for superficial surgery of the antero-medial and postero-medial surfaces of the arm, the cutaneous median brachial nerve (MBCN) and ICBN must be selectively blocked in addition to an axillary plexus block of the brachial plexus. In a randomized trial, these researchers compared the effectiveness of USG (USG) versus conventional block of MBCN and ICBN. A total of 84 patients undergoing upper limb surgery were randomized to receive USG (n=42) or conventional (n=42) blocks of MBCN and ICBN containing 1% mepivacaine. Sensory blockage was assessed by slight contact on the upper and lower half of the anteromedial and posteromedial surfaces of the arm at 5, 10, 15, 20 minutes after nerve blocks.
The primary endpoint was the proportion of patients who had no sensation after 20 minutes in the 4 regions innervated by MBCN and ICBN. Secondary endpoints were time of onset of general anesthesia, volume of local anesthesia, tolerance to withers, and American image quality. In the USG group, 37 patients (88%) had no sensation after 20 minutes in one of the 4 areas tested compared to 8 patients (19%) in the conventional group (pp. < 0.001). When general anesthesia was received, it occurred within 10 minutes in more than 90% of patients in both groups. The average total volume of the local anesthetic used to block MBCN and ICBN was similar in the 2 groups; In the United States, images were of good quality in only 20 (47.6%) of the 42 patients; 41 patients (97.6%) who received a USG block were comfortable with withers, compared to 16 patients (38.1%) in the conventional group (p < 0.001). The authors concluded that the U.S. guidelines improved the efficiency of the MBCN and ICBN blocks. Note that this guide applies more to diagnostic imaging than interventional procedures, Mulaik says. Most diagnostic ultrasounds in the emergency room are "focused" rather than "complete." As defined by the CPT, a limited ultrasound is an ultrasound in which less of the elements required for a complete examination are performed and documented.
Given the nature of focused ED ultrasounds, limited codes are usually the most accurate for use in the ED environment. For example, an abdominal ultrasound used to assess the presence of an abdominal aortic aneurysm would be reported as a “limited retroperitoneal ultrasound” (76775). In general, it is worth coding both for the ultrasonic guide and for the procedure performed.
