If you have any specific questions regarding shoulder ultrasound in your practice, please email me at firstname.lastname@example.org. I will add them with my response to the FAQ page if applicable.
Ultrasound is terrific at visualizing superficial structures such as the rotator cuff and the biceps. It is not ideal for visualizing a SLAP tear or a Bankart lesion. MR arthograms are superior to ultrasound to diagnose these conditions.
The four main features that I think you need to focus on are image quality, portability, customer support, and price point. The average orthopaedic surgeon needs one probe, basic MSK software, and good technical support if something goes wrong. If you are a hand or a foot & ankle specialist then I think it is worth it to purchase an additional probe for small joint applications. Go with a reputable manufacterer, and stick with the basics.
Talk to your CPA. There are significant tax benefits of a "capital lease" with a 1$ buy-out due to the IRS section 179 deduction on newly purchased business equipment.
Stay focused on the basics and focus on one or two joints to start with. If you go to a 2 or 3 day course covering everything head to toe, you may get overwhelmed. I observed this exact situation a few years ago when I was asked to critique a 2 day course on MSK ultrasound by one of the manufacturers. Covering every body part in quick sessions did not allow the docs to get comfortable with any one given anatomic section. Our one or two day hands-on courses focus on the shoulder, but also cover several other joints in depth. This allows you to focus and get skilled quickly.
Once you purchase an ultrasound machine, you will benefit from one-on-one or small group training. I have trained nearly one hundred physicians and PA's via this method and this is definitely getting the most bang for your buck. Instead of numerous practitioners from your medical group taking time out of your office and paying significant money to travel to a course, I come to you for the training. Contact me at email@example.com for details about this option.
Yes. There are CPT codes for extremity diagnostic ultrasound. The code for ultrasound-guided needle injection or aspiration is 76942. You also may bill for the office visit and the injection itself. Example: A patient comes in that you have been treating for hip pain. They had a new injury to their right shoulder. You examine their hip and shoulder. You decide to perform an in-office diagnostic ultrasound of their right shoulder. This reveals a partial thickness suprapsinatus tear. You discuss a cortisone injection with the patient, then perform a subacromial injection under ultrasound guidance. You may bill the office visit E&M code for a follow up visit, the diagnostic US code, the US guided injection code, and the actual injection code (20610). You also may bill the appropriate "J code" for the injectable drug such as lidocaine and depo-medrol.
Yes. You should store all pertinant images on a hard drive, a CD, or print a copy and put it in the chart. You should also create a report for every exam or procedure you perform. I have 2 different reports that I print, one for the diagnostic exam and one for the ultrasound-guided needle placement.
Yes. The most common use is for the shoulder, but there are many other body parts that can be visualized well. I have diagnosed achilles ruptures, gastroc tears, and quad ruptures among other things. I have injected numerous body parts utilizing ultrasound guidance including the hip, knee, carpal tunnel, FDL sheath and the biceps sheath.
Dr. DuBois practices in San Diego, California. His office address is:
5565 Grossmont Center Drive, Building #3, Suite #256, La Mesa, CA 91942.