Notes
Why POCUS?
- Enhanced Diagnostic Accuracy
- Provides real-time imaging to confirm or rule out conditions quickly.
- Improved Patient Care
- Facilitates faster decision-making and targeted interventions
- Reduces exposure to ionizing radiation; decreases need for patient transport
- Increased Efficiency
- Reduces the need for additional imaging studies and can streamline workflows.
- Improved Skills
- Studies have shown that POCUS improves physical examination skills, knowledge of anatomy, and clinical performance
Training in POCUS
- Most likely you didn’t get much of this in school (Robust training is rare in NP and PA programs)
- Good POCUS training is made up of three areas:
- Basic Concepts: Understanding ultrasound physics, equipment operation, and image interpretation.
- Hands-On Skills: Practicing scanning techniques on simulators and real patients under supervision.
- Clinical Integration: Applying skills to real clinical scenarios and interpreting findings within the context of patient management.
- How can I get POCUS training?
- Workshops and Courses: Enroll in POCUS training programs offered by medical institutions or professional societies. (Links below)
- SCCM
- CHEST
- SHM
- Online Modules: Utilize online platforms for self-paced learning and skill enhancement. (Links below)
- POCUS 101 (free)
- Toronto PIE (free)
- Practical POCUS ($)
- Butterfly ($)
- Mentorship and Peer Learning: Engage in hands-on sessions with experienced practitioners and participate in peer review.
- Workshops and Courses: Enroll in POCUS training programs offered by medical institutions or professional societies. (Links below)
Certification and Competency
- Certification and Competency are not the same, you can be competent without being certified (and probably vice versa!)
- Certification Programs
- Consider obtaining certification from recognized bodies, such as the American College of Emergency Physicians (ACEP) or the Society of Hospital Medicine (SHM)
- Somewhat controversial, needed or just spending money?
- My recommendation is: if you’re new and seeking training anyway, might as well do it in a way as to be certified; if you are experienced, probably little benefit in going back and obtaining certification
- Ongoing Education
- Stay updated with continuing education opportunities to maintain proficiency and integrate new techniques
- QA/QI: Really should have some sort of mechanism where someone else reviews your scan from time to time to ensure you are correct
Billing and Reimbursement
- Documentation Requirements (in general):
- Medical Necessity
- Written Interpretation
- Date and time of examination
- Name and hospital identification number of the patient
- Patient age, date of birth, and sex
- Name of the person who performed and/or interpreted the study, clinical findings
- Indication for the study, the scope (complete vs limited), and if this is a repeat study by the same provider, repeat by a different provider, or reduced level of service
- Impression (including when a study is nondiagnostic) and differential diagnosis, as well as the need for follow on exams and incidental findings
- Mode of archiving the data (where can the images be found to be viewed)
- Image Capture
- These are general guidelines, specific payors may have different rules and you should check with your billing department for confirmation
- CPT Codes: Current Procedural Terminology (CPT) codes related to POCUS.
- Professional fees
- Covers the cost of the provider’s services
- You can bill for this
- Technical Fees
- Covers the cost of the equipment, facilities, etc.
- Your hospital/practice can bill for this
- Important when it comes time to convince people to buy new machines
Some good POCUS Resources
Univ of Toronto Perioperative Interactive Education POCUS – Best interactive POCUS training
The POCUS Atlas – A free online image/clip repository
Society of Critical Care Medicine Advanced Ultrasound Course
CHEST Critical Care Ultrasonography – Society of Chest Medicine offers a Certificate in critical care ultrasound. This page details that process and includes links to the various courses that CHEST offers.
Society of Hospital Medicine POCUS Certificate – Like CHEST, the SHM offers a certification program for POCUS. This page contains information about the process as well as links to a number of different POCUS courses that can be used to meet certification requirements.
Point of Care Ultrasound Certification Academy – POCUS Academy is another option for certification
University of Utah Echocardiography and Perioperative Ultrasound – Lots of good cases, teaching videos, and more
Society of Point of Care Ultrasound (SPOCUS) – Lots of good teaching resources
DIY Ultrasound Phantoms – Want to make your own phantoms for ultrasound teaching?
Butterfly Ultrasound – Low cost handheld ultrasound device. This site also offers lots of educational resources; some free, some not.
VAVE Ultrasound – Bluetooth handheld ultrasound device. Lots of educational resources with purchase of device.
Practical POCUS – Site offering online and live POCUS courses
SonoSim – Online POCUS training with a simulator probe for practicing the kinetics of POCUS without an ultrasound or patients.
Resuscitative TEE Project – If you want to learn how to use transthoracic echocardiography in the ICU/ED, I can’t recommend this course enough!
POCUS Billing Info
Complete Ultrasound CPT Codes and Reimbursement Rates from POCUS 101
SPOCUS Reimbursement Statement – Society of Point of Care Ultrasound
critical care notes 