Ultrasound guided injections can position pain practices with several clinical and business advantages, says Neil Chatterjee, MD, a pain physician with Virginia Spine Institute in Reston, Virginia. "An ultrasound is a strategic addition to many practices, as it can improve outcomes for injections," he says. "During our residencies and fellowships, we learn to perform most peripheral joint injections in the absence of any guidance modalities. However, physicians may have a higher miss rate without the ultrasound guidance."
Dr. Chatterjee discusses the benefits of ultrasound guided injections and shares four insights on incorporating ultrasound into a pain management practice.
· Portable equipment
· Real-time imaging
· Targeted examination
· No radiation
· Patients can see their anatomy
"The ultrasound machine is very portable, so I can take it right to the exam room," says Dr. Chatterjee. He also notes that, “[Y]ou can see findings in real time. All you have to do is put the ultrasound probe over the knee joint and you can see the needle going into the targeted area. I know where I am, where I shouldn't be, and whether I'm not positioned properly. For example, I can target the anterior shoulder and perform the injection there, whereas I might be a little more cautious about performing that injection blind. Ultrasound also allows me to use the Doppler feature to visualize blood vessels. Another benefit is that patients love to see their anatomy on the screen while I'm explaining their findings with them. I can show them the abnormal knee joint and then place the probe over the other knee to compare the two. I can also use the ultrasound in a broader range of patients, such as pregnant women, because it doesn't use radiation."
· The equipment is reasonably priced.in comparison to other modalities
· Billing and coding is relatively easy.
· The transition to ultrasound guidance is relatively simple.
Dr. Chatterjee says, "The billing and coding for ultrasound guidance is CPT 76942 — there is a different code when using the ultrasound for diagnostic purposes. The ultrasound machine is reasonably priced and after learning how to use the equipment, transitioning the ultrasound into the practice is relatively easy."
However, Dr. Chatterjee says physicians must overcome the learning curve before using ultrasound in their practice. He recommends reading about ultrasound use and taking short courses on operating the equipment before purchasing one for your practice.
"There are several websites and various organizations that have videos and literature on using ultrasound for each specific joint," says Dr. Chatterjee.
1. Optimize patient visualization. "I can show patients exactly where their cartilage, muscle, nerves, tendons, and arteries are, and I can show them I'm not going to hit the artery," he says. "Before the injection, I'll use the ultrasound to make sure there is no major fluid in the joint. Prior to injecting the affected area, I use the ultrasound for proper localization. I then make a mark on the patient's skin, sterilize the area, and place the probe over the marked area, followed by the insertion of the needle. Ultrasound shows me exactly where my needle is inserted. If my positioning is not exactly on target, I can reposition the needle without withdrawing it completely."
2.Ultrasound does not necessarily replace other diagnostic modalities. For instance, while ultrasound can be used for diagnostic purposes, and is cheaper than ordering an MRI, Dr. Chatterjee says this does not always take the place of an MRI. Ultrasound is very useful in visualizing tendon structure, cartilage, and other superficial structures. MRI is more specific in detecting deeper structures within the bone and joint.
3. Use a lot of gel. As with any ultrasound machine, physicians should make sure they apply a large amount of gel to the viewing site so they have clear visualization. "It's important to plenty of gel. Putting an adequate amount of gel really augments your ability to see what is critical," Dr. Chatterjee says.
4. Start small and expand your use. There are several ways physicians can use ultrasound technology, which is important to remember even after bringing the machine into your practice. Physicians can begin by using the ultrasound for guided knee injections, and then add shoulder, elbow, and finger injections as well.
"The best way to enhance your practice is to learn about ultrasound and there are numerous organizations that provide courses," says Dr. Chatterjee. There are educational materials available and ultrasound protocols for all joints which guides you through pictures on how to position a person and view their anatomy. The key is to keep learning and stay informed on ultrasound use."
CPT copyright 2008 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
Related Articles on Orthopedic Surgery:
7 Points About Personalized Partial Knee Replacements in Surgery Centers
10 Ways to Strengthen Orthopedic Practices in 2012
12 Statistics on Sports Medicine Physician Compensation
Dr. Chatterjee discusses the benefits of ultrasound guided injections and shares four insights on incorporating ultrasound into a pain management practice.
Clinical advantages
There are several advantages to using ultrasound guidance for pain management injections instead of x-ray or fluoroscopy, says Dr. Chatterjee. Those advantages include:· Portable equipment
· Real-time imaging
· Targeted examination
· No radiation
· Patients can see their anatomy
"The ultrasound machine is very portable, so I can take it right to the exam room," says Dr. Chatterjee. He also notes that, “[Y]ou can see findings in real time. All you have to do is put the ultrasound probe over the knee joint and you can see the needle going into the targeted area. I know where I am, where I shouldn't be, and whether I'm not positioned properly. For example, I can target the anterior shoulder and perform the injection there, whereas I might be a little more cautious about performing that injection blind. Ultrasound also allows me to use the Doppler feature to visualize blood vessels. Another benefit is that patients love to see their anatomy on the screen while I'm explaining their findings with them. I can show them the abnormal knee joint and then place the probe over the other knee to compare the two. I can also use the ultrasound in a broader range of patients, such as pregnant women, because it doesn't use radiation."
Business advantages
From a business standpoint, incorporating ultrasound guidance makes sense for multiple reasons, including:· The equipment is reasonably priced.in comparison to other modalities
· Billing and coding is relatively easy.
· The transition to ultrasound guidance is relatively simple.
Dr. Chatterjee says, "The billing and coding for ultrasound guidance is CPT 76942 — there is a different code when using the ultrasound for diagnostic purposes. The ultrasound machine is reasonably priced and after learning how to use the equipment, transitioning the ultrasound into the practice is relatively easy."
However, Dr. Chatterjee says physicians must overcome the learning curve before using ultrasound in their practice. He recommends reading about ultrasound use and taking short courses on operating the equipment before purchasing one for your practice.
"There are several websites and various organizations that have videos and literature on using ultrasound for each specific joint," says Dr. Chatterjee.
4 Insights on ultrasound use
Here are four insights from Dr. Chatterjee for pain management physicians who are considering incorporating ultrasound into their practices.1. Optimize patient visualization. "I can show patients exactly where their cartilage, muscle, nerves, tendons, and arteries are, and I can show them I'm not going to hit the artery," he says. "Before the injection, I'll use the ultrasound to make sure there is no major fluid in the joint. Prior to injecting the affected area, I use the ultrasound for proper localization. I then make a mark on the patient's skin, sterilize the area, and place the probe over the marked area, followed by the insertion of the needle. Ultrasound shows me exactly where my needle is inserted. If my positioning is not exactly on target, I can reposition the needle without withdrawing it completely."
2.Ultrasound does not necessarily replace other diagnostic modalities. For instance, while ultrasound can be used for diagnostic purposes, and is cheaper than ordering an MRI, Dr. Chatterjee says this does not always take the place of an MRI. Ultrasound is very useful in visualizing tendon structure, cartilage, and other superficial structures. MRI is more specific in detecting deeper structures within the bone and joint.
3. Use a lot of gel. As with any ultrasound machine, physicians should make sure they apply a large amount of gel to the viewing site so they have clear visualization. "It's important to plenty of gel. Putting an adequate amount of gel really augments your ability to see what is critical," Dr. Chatterjee says.
4. Start small and expand your use. There are several ways physicians can use ultrasound technology, which is important to remember even after bringing the machine into your practice. Physicians can begin by using the ultrasound for guided knee injections, and then add shoulder, elbow, and finger injections as well.
"The best way to enhance your practice is to learn about ultrasound and there are numerous organizations that provide courses," says Dr. Chatterjee. There are educational materials available and ultrasound protocols for all joints which guides you through pictures on how to position a person and view their anatomy. The key is to keep learning and stay informed on ultrasound use."
CPT copyright 2008 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
Related Articles on Orthopedic Surgery:
7 Points About Personalized Partial Knee Replacements in Surgery Centers
10 Ways to Strengthen Orthopedic Practices in 2012
12 Statistics on Sports Medicine Physician Compensation