Case Study

It has been shown to reduce the time to diagnosis and reliance on traditional radiology referrals.¹ The development of affordable, portable hand-held ultrasound devices has further facilitated the adoption of POCUS among primary care providers, improving patient care. POCUS is now used for non-invasive assessments across various conditions, including pregnancy evaluation, aortic screening, breathing difficulties, abdominal pain, and musculoskeletal injuries.

Research indicates that POCUS significantly enhances diagnostic accuracy in outpatient settings. In one study, the use of POCUS in primary care led to fewer specialist referrals, saving time and reducing overall care costs. Adding POCUS to the standard history and physical exam resulted in a 49% change in initial diagnoses, an 89% increase in diagnostic confidence, and modifications to initial management plans in 51% of cases. Moreover, planned referrals to secondary care decreased by almost half (49% to 26%).²

A 2019 systematic review supported the broad utility of POCUS in primary care, demonstrating its effectiveness across diverse clinical applications. The study highlighted improvements in diagnostic accuracy, time to diagnoses, and more efficient treatments, particularly in obstetric evaluations, aortic screenings, lung assessments, and deep vein thrombosis (DVT) diagnoses.³

Recognizing the documented benefits of POCUS, the Accreditation Council for Graduate Medical Education (ACGME) introduced updated POCUS training requirements for family medicine residents in 2023. POCUS education and competency are now mandatory for all accredited family medicine residency programs.^4
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The Value of POCUS for Primary Care Clinicians

POCUS offers primary care providers several key advantages:

1. Improved Clinical Decision-Making: Incorporating POCUS into history and physical exams enables real-time, accurate diagnoses, leading to faster treatment decisions and reduced need for additional diagnostic tests or referrals.
2. Enhanced Doctor-Patient Engagement: The ability to provide immediate imaging results strengthens doctor-patient relationships and boosts patient satisfaction.
3. Financial Benefits: POCUS generates new revenue streams through direct billing and upcoding of Evaluation and Management (E&M) services. Additionally, it improves workflow efficiency, enhancing overall productivity.

POCUS Billing Guidelines

Primary care providers can bill for “limited ultrasound exams” when using POCUS in outpatient settings. However, they must comply with Current Procedural Terminology (CPT) and Centers for Medicare and Medicaid Services (CMS) guidelines:

• The exam must be medically necessary.
• It must be ordered and performed by a licensed provider.
• Relevant images (at least one) must be archived and retrievable.
• The interpretation of the POCUS exam must be documented in the medical record.

Adherence to these criteria ensures compliance with regulatory standards and enables reimbursement by third-party payers and government programs.

Case Study: Implementing POCUS in a Family Medicine Practice

Dr. Stephen Erickson, a family medicine physician, successfully integrated POCUS into his full-spectrum practice. Imaging applications used included obstetrics, pediatrics, musculoskeletal imaging, and ultrasound-guided injections. His case study highlights the clinical and financial benefits of adopting POCUS in primary care.

Over a one-year period, Dr. Erickson performed 282 POCUS exams and collected data on billing outcomes, gross charges, net revenue, and payor acceptance. He collaborated with billing specialists to develop workflows aligned with CPT and CMS guidelines. This included creating standardized templates within the electronic health record (EHR) to ensure compliance and efficient documentation.

Implementation Challenges

1. Training: A standardized training program was implemented to teach clinicians proper techniques for image archiving, documentation, and billing.
2. Workflow Optimization: POCUS was integrated into the existing IT infrastructure, including the EHR and Picture Archiving and Communication System (PACS). Dr. Erickson’s practice used Butterfly Compass™ software, enabling seamless data storage and retrieval while minimizing disruptions to clinical workflows.

Results and Billing Outcomes

• Procedures Performed: Most common exams included obstetric (CPT 76815), joint injections/aspirations (CPT 20611), lung (CPT 76604), cardiac (CPT 93308), and DVT (CPT 93971).
• Denial Rates: Ranged from 0% (obstetric) to 50% (cardiac and DVT), with common reasons including bundled payments, lack of prior authorization, and restrictions in rural practice settings.

Financial Summary

Dr. Erickson recovered his initial investment within the first year. Assuming the device’s 3-year warranty, ongoing costs involve only software licensing and minimal equipment, improving return on investment over time.⁴

Patient Satisfaction and Payor Cost Savings

Patients appreciated receiving immediate results during visits, avoiding follow-ups and additional testing. Dr. Erickson noted that some POCUS exams prevented costly interventions, such as emergency department visits, resulting in substantial savings for payors. For example, a single POCUS-confirmed DVT saved an estimated $1,500–$2,000 in emergency care costs. Modeling a 10% reduction in additional testing or referrals projects annual savings of $56,000.