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Gastroenterology Coding Alert

Coding Tactics for Fluoroscopy Used in GI Procedures

" The digestive section of the CPT 2001 manual contains several new cross-references that explain which radiological code should be reported when fluoroscopic guidance is provided during a gastrointestinal procedure. While this is some help to gastro coders, many procedures that frequently use fluoroscopic guidance still do not contain a cross-reference, making it unclear which radiological code to report.

Fluoroscopy is a continuous x-ray technique that gastroenterologists may use with or without contrast material to provide visual guidance, according to Bergein F. Overholt, MD, FACP, MACG, a gastroenterologist in Knoxville, Tenn., and past president of the American Society for Gastrointestinal Endoscopy. While the most common use of fluoroscopy is during ERCP (43260), it may also be incorporated into other procedures such as esophageal dilations or percutaneous gastrostomy (PEG) tube placements.

When a gastrointestinal procedure and an imaging, such as fluoroscopy, are performed together, the imaging portion is designated as radiological supervision and interpretation. In this instance, two separate CPT codes should be reported to describe the combination of services provided.

Fluoroscopy Not Mentioned in Code Descriptor

Matching the correct radiological supervision and interpretation (S&I) code with a GI procedure code is made more complicated, because very few of the radiological code descriptors include the word fluoroscopy. For example, 74360 (intraluminal dilation of strictures and/or obstructions [e.g., esophagus] radiological supervision and interpretation), which should be reported when fluoroscopic guidance is used in combination with an esophageal dilation, never mentions the word fluoroscopy.

Thats because fluoroscopy is not the only method of imaging guidance that can be used during a dilation of strictures, says Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies, Inc., an Atlanta-based firm that supports 1,000 radiologists and 350 physicians from other specialty areas. The 70000-series codes in CPT are really designed for radiologists, so physicians of any other specialty are going to have difficulty understanding how to use them.

Use 76000 as Last Resort

Many gastroenterologists make the mistake of reporting 76000 (fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 70134 [e.g., cardiac fluoroscopy]) when they use fluoroscopy, which could cost them reimbursement dollars. For example, the 2001 transitioned facility relative value units (RVUs) for 76000-26 (professional component) is only .24, versus a comparable RVU of .77 for 74360-26. (Whether to use modifier -26 is explained later in this article.)

Although its descriptor includes the word fluoroscopy, 76000 should only be used when a more specific code is not available, Parman says. What you dont want to do is use a code that looks close [...]