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June 8, 2012

ARDMS Updates and Headlines in the News:

Apply Today - ARDMS is Now Accepting Applications For the First Administration of the Registered in Musculoskeletal™ (RMSK™) sonography Credentialing Examination

ARDMS Releases the MSK Prerequisite for the Registered in Musculoskeletal™ (RMSK™) sonography Credentialing Examination (This link opens a PDF document. To download the latest version of Adobe Reader, click here)

Read the ARDMS MSK How to Apply Guide

ARDMS: Important Testing Center Update

Incomplete Abdominal Ultrasound Documentation Leads to Income Loss

Special Ultrasound Detects Heart Problems in Rheumatoid Arthritis Patients

ARDMS: Important Testing Center Update

• At the test center, you must present two current, valid signature IDs, one of which must be a non-expired government-issued photo ID with your signature; see the accepted list of IDs here.
• The name on your application must EXACTLY MATCH the name on both current, valid signature IDs.
• Jane R. Doe and Jane Rachel Doe DO NOT EXACTLY MATCH.
• Failure to present two acceptable IDs will prevent your admission to the test center. If this happens, you will be marked absent and you will forfeit the entire examination fee and seat.
• If the names do not EXACTLY MATCH, update your ARDMS name of record. 

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Incomplete Abdominal Ultrasound Documentation Leads to Income Loss

Incomplete documentation in abdominal ultrasound reports is common and contributes to loss of revenue at many practices, according to a new study published in the June issue of the Journal of the American College of Radiology.

Tennessee researchers assessed the frequency, characteristics, and financial impact of deficiencies in physician documentation in abdominal ultrasound reports. They found that not only is it common for reports to be inadequate, report deficiencies resulted in lost income of more than 5% (JACR, June 2012, Vol. 9:6, pp. 403-408).

Physician documentation is necessary for CPT coding, which is a crucial part of the payment process, wrote lead author Dr. Richard Duszak, of Mid-South Imaging and Therapeutics in Memphis, and colleagues. When report documentation is incomplete, undercoding can result.

Duszak's study included 12.7 million radiology reports from 37 practices to identify and analyze abdominal ultrasound reports. (For a correctly documented abdominal ultrasound CPT code, description of eight elements must be included: liver, gallbladder, bile ducts, pancreas, spleen, kidneys, abdominal aorta, and inferior vena cava.)

Using standard CPT criteria, the team categorized exams as complete (all eight required elements documented) or limited (fewer than eight elements included). Within the limited documentation group, reports were categorized as "very likely complete" when seven or eight elements were documented, "likely complete" when at least six elements were documented, and "possibly complete" when at least five elements were documented.

Of 336,062 abdominal ultrasound reports by 1,136 radiologists:

75.1% documented all eight elements for CPT coding as complete examinations
7.7% documented seven elements
5.6% documented six elements
4.8% documented five elements
13.5% documented four or fewer elements

For very likely, likely, and possibly complete examination models, the researchers found report deficiencies in 9.3%, 15.5%, and 20.2% of cases, respectively, which resulted in declines of 2.5%, 4.2%, and 5.5% in legitimate professional payments.

Of 106,168 examinations labeled "complete," 87.4% fulfilled CPT criteria, the group found. In 60.6%, reports were erroneous or too ambiguous for code assignment. The spleen (41.2%) was the most frequent element neglected, and documentation deficiencies were less frequent for high-volume radiologists.

How can radiologists improve their reports -- and avoid underpayment? Structured reporting could help, according to Duszak and colleagues.

"Radiologist documentation deficiencies in abdominal ultrasound ... collectively contribute to substantial losses in legitimate professional revenue," they wrote. "In addition to increased physician training, structured reporting tools may help practices improve the overall quality of their radiology reports.

View the article online.

Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.

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Special Ultrasound Detects Heart Problems in Rheumatoid Arthritis Patients

A special type of ultrasound - speckle-tracking echocardiography - can detect potentially fatal heart complications in rheumatoid arthritis patients, researchers from the Mayo Clinic, USA reported. The researchers explained that individuals with rheumatoid arthritis have a higher chance of developing heart disease, and for them early intervention is vital. However, risk assessment tools currently used by doctors tend to underestimate the danger.

Senior researcher, Sherine Gabriel, M.D., explained that speckle-tracking echocardiography shows promise as an effective way of screening rheumatoid arthritis patients for cardiovascular disease.

Dr. Gabriel said:

"The challenge that we've had in our studies, and other people have had as well, is identifying patients with rheumatoid arthritis early enough so that we can intervene, before the symptoms become clinically apparent.

So before they have a heart attack, before they have heart failure, so that we can identify those high-risk patients early, at a time when we can make a difference."

The immune system of patients with rheumatoid arthritis attacks tissue, inflames joints and sometimes affects other organs too. A Mayo Clinic study that was recently published found that the Framingham and Reynolds risk scores, two commonly utilized heart disease risk assessment tools, frequently underestimate the danger rheumatoid arthritis patients face.

Individuals with rheumatoid arthritis are in danger of two cardiovascular conditions; the type of heart disease that causes heart attacks to occur, and the type that causes heart failure, according to Dr. Gabriel. Gabriel and team are working to create a more accurate and effective risk assessment tool. Meanwhile, however, they say the echocardiogram findings are a step in the right direction.

In this study, involving 100 patients with rheumatoid arthritis and no cardiovascular disease diagnosis, as well as 50 others with no heart disease or rheumatoid arthritis, those with rheumatoid arthritis where shown to have cardiac impairments when scanned with the speckle-tracking echocardiography. The healthy cohorts showed no such impairments.

Dr. Gabriel added that the impairment found in the arthritic patients had a unique pattern - a sign that could be used to indicate heart disease before any clinical signs become apparent.

Dr. Gabriel said:

"It's potentially part of the answer. Our research team here at Mayo is working to identify better ways to predict heart disease in persons with rheumatoid arthritis, including developing better risk scores, imaging tests and perhaps better blood tests.

We're also evaluating a number of immunological blood tests that could help us identify patients early, and exploring better imaging approaches like myocardial strain that can help us identify patients with RA who have heart problems as early as possible."

View the article online

Article written by staff at medicalnewstoday.com and adapted for the purposes of this newsletter.

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