Zydron: Insights on UnitedHealthcare's new radiation policy/POCUS + what it means for Emergency Physicians

By Courtney Zydron, MD, MBA
VACEP Secretary & President, Williamsburg Emergency Physicians Inc.

As UnitedHealthcare rolls out new reimbursement policies, emergency physicians are facing questions about how these changes might impact their practice. For those relying on point-of-care diagnostics like POCUS (Point-of-Care Ultrasound), understanding the nuances of these policies is crucial, according to Dr. Courtney Zydron, a VACEP board member.

“The recent policy changes by UnitedHealthcare present a significant shift in how radiology services are reimbursed,” explained Zydron. “For emergency medicine physicians, particularly those performing POCUS, this could lead to uncertainties around payments if the interpretation is embedded within the ED note rather than documented as a separate report.”

UnitedHealthcare’s new guidelines indicate that when a radiology service is provided and only reviewed rather than receiving a comprehensive written interpretation, the reimbursement will be part of the Evaluation and Management (E/M) service. Furthermore, interpretations appended with modifier 26 will not be eligible for separate reimbursement if reported on the same day as an E/M service -- unless a standalone radiology report is provided."

What Can You Do?

Zydron

• Evaluate Your Documentation Practices: Ensure that your POCUS interpretations are clearly documented. Consider creating a separate note to avoid ambiguity and potential reimbursement issues with UnitedHealthcare or other payers in the future.

• Stay Vigilant with Reimbursement Patterns: With these new policies in place, it’s crucial to monitor your reimbursement, particularly after the October 1 policy rollout. Identify any discrepancies early to address them proactively.

• Stay Updated: As the industry watches how UnitedHealthcare enforces these changes, it’s essential to remain informed and ready to adapt as needed. 

For those wanting to dive in, here's UnitedHealthcare's Reimbursement Policy Update.

If you have specific concerns or experience reimbursement issues, share them so we can help advocate at the state and national levels.