In-Office Ultrasound Provides Benefits to Both Patients and Physicians

Other options for obtaining the necessary equipment can include sharing equipment between specialty groups. If the geographic and scheduling logistics can be coordinated between offices, the sharing of equipment can significantly reduce the startup cost of initiating in-office ultrasound.

Leasing of ultrasound equipment can also be considered as an alternative to purchasing the equipment outright.

Training

Although there are currently no certification requirements for the use of in-office ultrasound, several organizations are in the process of developing guidelines. Organizations including the American College of Emergency Physicians and the American Institute of Ultrasound in Medicine have recommendations in place for education, training, and supervised performance before a physician uses ultrasound independently.

The Otolaryngology-Head and Neck Surgery study identifies organizations which currently offer certification courses for head and neck ultrasound. These include:

• American College of Surgeons (ACS)
• American Association of Clinical Endocrinologists (AACEO)
• Radiological Society of North America
• American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)

The ACS certification program is modular in concept. Participants are required to first complete the basic core module, which is available on CD-ROM. This module covers introduction to the program, ultrasound physics, instrumentation and scanning technique, and clinical applications.

Following successful completion of the basic core module, the physician must then complete the advanced module(s) in his or her area of interest. The head and neck module is an eight-hour curriculum that includes:

• Physics and principles of ultrasound
• Scanning techniques and normal head/neck ultrasound anatomy
• Head/neck ultrasound interpretation
• Interventional head/neck ultrasound

(ACS Web site. Available at www.facs.org/education/ultrasound.html . Accessed January 26, 2007.)

The cost of the ACS certification varies according to level of ACS membership. The cost for the CD-ROM for the basic core module ranges from $90 to $300. The eight-hour head and neck advanced module costs $775.

Dr. O’Malley completed the ACS certification program under the tutelage of Robert A. Sofferman, MD, Head and Neck Module Director. He found the training to be extremely reasonable, easy to learn, easy to apply, and not at all cumbersome. He estimates that following his formal training, it took him only about two months of using ultrasound on his own before he felt very comfortable and proficient at seeing the structures in the neck. He was able to quickly and easily train his nurse and nurse practitioner to set up the equipment and assist him with ultrasound examinations.

Reimbursement

Dr. Akbar et al. concluded that the primary issue regarding proper reimbursement for in-office ultrasound and USFNA is utilization of the correct CPT codes. As with all medical insurance billing, improper coding can result in a significant loss of revenue.