Renal Ultrasound By Nephrologists: Frequently Asked Questions

What are the advantages of nephrologists doing kidney ultrasounds? The main advantage is that you know what you’re looking for during the scanning and have the clinical information necessary to appropriately interpret the study. A good example is kidney length, an important parameter in clinical decisions concerning CKD, which is frequently undermeasured. Another major advantage is convenience for the patient and the ability to complete the workup in a single visit.

Can I get reimbursed for performing and/or interpreting a renal ultrasound? Yes, provided that you obtain and store the appropriate images and generate a report. I have never had a charge denied because I am a nephrologist and I am not aware that this has happened to anyone else.

How can I get trained? Introductory workshops are frequently offered at society meetings and are a good way to see what’s involved (and how easy it is). However, more extensive training is required to become competent. At Emory, we offer a comprehensive week-end course and a week-long minifellowship to gain additional experience with performance and interpretation.

How long does it take to become competent? Kidneys are one of the easiest organs to examine due to their location, limited anatomic variability, and limited range of pathology. Training time varies from person to person and the range of pathology. Based on a long experience training nephrology fellows, I estimate an average of 20-30 exams with some supervision and an additional 15-20 with intermittent supervision for difficult studies or interpretation issues.

What if I miss a finding? I get this question all the time, usually in reference to renal masses. Yes, you will miss small mases but this is a limitation of ultrasound, which often cannot resolve small masses. If a mass is detectable by ultrasound, you will usually be able to see it. If you are unsure of something, you can always order additional imaging.

Do I need any type of certification? Certification is available from the American Society of Diagnostic and Interventional Nephrology. It is not required for reimbursement but may be required for credentialling in some practices/institutions.

Can sonography be incorporated into nephrology training programs. Absolutely. It has been a formal rotation for our renal fellows since 1996. All our fellows graduate fully trained in renal sonography, an important skill they can incorporate into their future practice. Even if they don’t end up doing ultrasounds in their practice, they can better interpret the studies that they order.

Can my staff perform the studies? Yes. Only New Hampshire, New Mexico, North Dakota, and Oregon require sonographers to be licensed.

How much does the equipment cost? Standard abdominal scanners adequate for renal ultrasounds range from $30,000 to $50,000. Hand-held scanners are significantly less but may not have adequate resolution, field of view, or imaging options. Another less expensive option is used equipment, which is readily available. This is all discussed in detail in the 2-day course at Emory. 

How much is the reimbursement for a renal ultrasound? This depends on a lot of factors but the average reimbursement for renal ultrasounds at Emory in 2023 was $163 for outpatient studies and $46 for inpatient studies. The current Medicare reimbursement ranges from $104 to $151 for outpatient studies. In a busy outpatient practice, the cost of the equipment can easily be recouped.