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fluoroscopy in the office

Karen Posted Wed 03rd of October, 2012 13:33:27 PM

We have a xray machine(mini c arm) that has fluoroscopy capabilties. When we take still pictures how should we bill these and code for them. Sometimes we do fluoroscopy pictures. We have been told by the company that sold us the machine to bill 76000 no matter what. We are getting denied for them all. We would appreciate any help in this matter.

SuperCoder Answered Wed 03rd of October, 2012 15:56:43 PM

Try Adding Modifier 26.

Although the fluoroscopy codes 76000 and 76001 specifically refer to "physician time," most carriers still require practices to append modifier -26 (Professional component) if the orthopedic surgeon performs the fluoroscopy.

If you report 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) or 76001 (Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]) with your surgical claims, you have probably heard varying guidelines regarding whether you should append modifiers -TC (Technical component) and -26 to your fluoroscopy codes. Many orthopedic practices believe that because these codes refer to "physician time," the physician can report the global fee without any modifiers. This is not the case, however, with most Medicare carriers.

Karen Posted Wed 03rd of October, 2012 16:32:24 PM

Do we still use 76000 for still pics? Or do you use xray codes depending on the number of views taken?

SuperCoder Answered Wed 03rd of October, 2012 17:00:20 PM

June 2008 CPT Assistant offers some insights into proper fluoro coding. E.g., you have to watch supervision requirements. This excerpt also indicates you may report an anatomy-specific x-ray code if the fluoro machine creates a permanent image and there’s a formal report:
“… The choice of radiological imaging guidance code is based on the procedures performed and documented in the medical record. Because fluoroscopic imaging requires personal supervision, a fluoroscopic code should not be submitted if the physician is not present in the operating room during a procedure that uses fluoroscopy or fluoroscopic guidance. However, the appropriate radiographic code to report the anatomy evaluated should be submitted in the event that a) the radiologist's contract with the hospital requires that a radiologist issue a formal interpretation, or b) the physician performing the study requests that a radiologist produce a formal report of the procedure from permanent images recorded. …”

The article goes on to say 76000 is appropriate when it’s the only imaging or there’s no more appropriate code (so the fluoro isn’t bundled into another imaging code):

“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.”

ICD-9 Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

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