I think I think a big one that I think we need to tackle is the fiber scans. I said answer live but I'm not the only one that's going to answer this because I, you know, Dr. Lindbergh's got a little bit of intake on this one as well because this one causes much confusion to a lot of practices doing fiber scans. Okay, am I not seeing this one could you read that for me for some reason I'm not what is the difference between codes 91200 and 76981 those are the there's a fiber scan and livery lastography code. Okay, well let's go around the table on that one then. All right. Go ahead, Dr. We're deferring to you on this one. I'm going to say is probably going to be and remain controversial and will update some discussions we've had through email exchanges, you know, over over recent months. The codes were originally valued 91200 the fiber scan vibration control the lastography fiber scan I think is the only technique device used in the United States for this. It was valued and actually revalued a few times till it seemed to be gotten right and it's not paid very much and that's largely because Medicare assigned a very low practice expense to it making some bad assumptions about how frequently it's done. It wasn't that the physician work was all that badly valued. Later, an ultrasound based lastography code was developed and passed. And it was, you know, separate and that was basically using 76981 type code or limited ultrasound. Recently, the company that markets fiber scan has been saying you can use that ultrasound code because the device does use an ultrasound be wave, you know, the physics of it does utilize it, even though the report itself does not show an image of the liver, it does show a image of a sort. If anybody's seen what a fiber scan report looks like there there are a bunch of little images arrayed, which have nothing to do with what an ultrasound of the liver actually looks like when you're trying to look at the entire organ. Okay, we had some discussions recently with the ACR with American radiology folks, trying to see if they would put in writing reasons why we they thought we cannot should not use the ultrasound code, and they won't do that. So we concluded, as our CPT ruck advisors discussed it from the three societies well there's really nothing that prohibits you using that ultrasound code. AMA was kind of asking for some clarification on this and we don't really have anything further to tell them. So we're not going to go back to the company and say you're wrong. We're not going to go back to the company and say you're correct. But at this point we don't see any reason why you could not follow what the fiber scan people are saying and use the ultrasound 76981 code which pays substantially more as it happens. So I'm going to have a discussion with with our coding folks and probably change the way we build fiber scans. There may be some future further word on the subject but this is where it seems to stand right now. And you just will not find much written in print because it's it's kind of unofficial controversial but I think it's legit. There we are. I mean I, I'll be honest with you, you know, we get that question. Yeah, got that question a lot it was like a wave of nothing but fiber scan questions I at one point in time and I know I was going back and forth I was reading all these emails, emails from the practice doctor you and I was like, you know, I was getting kind of confused but I get it. I understand why there's a very small difference between the two but I get that it's not truly a full ultrasound of the liver but they use it so yeah I don't know. I guess yeah that's what I would say bill it. I mean if that's what the guidance we've gotten and nobody will put it in writing not to and that's what they're doing. We've had some practices that will not change, because they live in fear that they're going to end up paying back the community so you know I think until they have written policy to do that, or some further guidance I think there's going to be a back and forth on this one definitely think we need to put kind of a little sidebar, like, you know, here are your two codes. Yeah, I mean I've been told some very large GI practices have been using the ultrasound code for quite a long time now and there's been no pushback from any specific pair. Good. I'm going to sneak in one more question and then so for those of you who we don't answer your question live please look in the box we are typing in answers or I should say our presenters are typing in answers. When another presenter is is actively speaking. Before we break I'll just ask the for the infusion poll question, what if the infusion services are being done by a biologic infusion company and not by the position office staff. Well, if the place of service is still office. Yeah, to me the question is, which provider is I mean let's let's say there's an infusion company that comes in uses one of my exam rooms I let them do it free or I get you know some little sublease rent that's based on market rates. Yeah, it's always a physician in the office. Even though, you know, there's no interaction with the patient. You know, nothing bad ever happens. You know, is that still legit can they report, let's say me as the supervising physician because I'm there during that day, even though I'm not part of their company, not paid by them. There may not be an answer, but this is a rare situation.

91200

76981

fiber scans

liver elastography

ultrasound-based lastography