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Michelle Posted Wed 24th of January, 2018 13:32:20 PM
Our physician recently purchased a c-arm for use in the office. He gave a patient an injection using fluoroscopy for guidance (77002). Do I use 76000 with modifier 59? Also, Medicare is denying claims for 73140. Is it appropriate to bill the office visit (99213) and 73140 on the same claim with type of service (TOS) 4 (Diagnostic Radiology)? What is the correct way to bill 73140? Thank you
SuperCoder Answered Thu 25th of January, 2018 01:47:40 AM


>Code 76000 may be reported when fluoroscopy is the only imaging performed. For example, a patient presents to the radiology department with a prior joint x-ray series demonstrating a calcified body near the joint. The physician uses fluoroscopy with the joint flexed, extended, and rotated to determine whether the calcification is indeed loose within the joint. Because fluoroscopy is the only imaging procedure performed at that patient encounter, code 76000 is reported once (not for each joint position examined).

>Another example is when there is no other fluoroscopy code that more accurately describes the imaging performed (ie, code 77001, 77002, or 77003). For example, a patient steps on a needle, and fluoroscopy (C-arm) is used to assist the physician to locate and remove this foreign body from the skin wound. In this instance, if C-arm fluoroscopic imaging is being provided without a diagnostic radiologic examination (ie, no hard copy record of the images is produced), then code 76000 should be used to identify the imaging procedure provided. Because code 76000 is designated as a separate procedure, modifier 59, Distinct Procedural Service, should be appended and reported in addition to the appropriate codes from the Integumentary System section.

>>Code >77002, Fluoroscopic guidance for needle placement (eg, biopsy aspiration, injection, localization device)>, is intended to be used to report fluoroscopic guidance during injection procedures when fluoroscopic guidance is required in the performance of needle placement in areas other than the spine, for pain management injection procedures. Codes 76000 and 76001 differ in that the descriptors do not specifically identify fluoroscopic guidance for a procedure involving needle or device placement.

>>Also, about your another question, using 99213-25, 73140.

>Normally same physician doesn't perform both. If anyone performs and bills both together, the physician would prefer billing in two different ways.
If the X-ray has very low fee value, then the physician will be billing higher level of Office Visit by including x-ray being a factor in MDM (not billing x-ray separately), to get higher reimbursement.
If the X-ray is of very higher value, then considering only ordering of x-ray as part of MDM component of Office Visit, the performance of x-ray is billed separately. In such a situation, he can use modifier 25 with Office Visit codes.

>So, bill as per your documentation. 

>Hope that helps!

Michelle Posted Fri 26th of January, 2018 15:04:04 PM
Please clarify the correct billing for the physician performing and evaluating the x-ray during an office visit. For example a patient complains of thumb pain, 3 views of the thumb ray were obtained and they all showed moderate first metacarpal trapezial arthritis with joint space narrowing and spur formation. Do we bill 99213 for the office visit with modifier 25 and 73140 with the type of service (4) Diagnostic Radiology?
SuperCoder Answered Mon 29th of January, 2018 00:34:52 AM

Whether or not the modifier is needed to avoid denials may all depend on your payers and their guidelines. 

You can add the 25 modifier to the E/M as this is a separately identifiable service. 

You can bill 99213-25, 73140. 

Hope that helps!

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