november 2014

Reporting Fluoroscopy Codes

It seems like there are a number of coding topics where there are varying opinions on whether or not a certain CPT code should be additionally reported and fluoroscopy happens to be one of those topics.

There is a recent CPT Assistant article published in September 2014 and I want to address some of the more pertinent information that’s discussed in the article.

1. “Because the CPT code set includes specific reporting instructions, it is important to refer to the code descriptor language, parenthetical notes, cross-references, and section or subsection guidelines provided in the CPT code set.”

  • When a CPT code descriptor includes the phrase “with image guidance” as in the facet injection codes (64490-64495) or “with imaging guidance” as in the transforaminal injection codes (64479-64484) then fluoroscopic guidance is included in the primary procedure and not additionally reported.
  • Carefully read the parenthetical notes with ALL CPT codes. For example, if you look at CPT code 36597 the code descriptor reads – “Repositioning of previously placed central venous catheter under fluoroscopic guidance” – one might take that to mean that fluoroscopic guidance is again included in the primary procedure, BUT the parenthetical notes under this code state (FOR FLUOROSCOPIC GUIDANCE, USE 76000) so in this instance fluoroscopy is reported in addition to CPT code 36597.
  • Directly under certain CPT codes you will notice that there may be CPT Assistant references along with the date and page number for specific articles related to the code listed above them. These are your cross-references. Now look at CPT code 63650 Percutaneous implantation of neurostimulator electrode array, epidural. Notice that nowhere in the code descriptor does it mention the use of image guidance, so in this case would you report fluoroscopy if used? The answer is NO, because when you follow the cross reference to CPT Assistant article August 2010 it states that “fluoroscopic guidance is considered inherent to the percutaneous implantation procedure” even though that information is not included in the code descriptor.

So that still leads us back to the original question of – “When should you report fluoroscopy?” Once you have followed the instructions in Part 1 and determined that there are no guidelines relating to fluoroscopy reporting CPT Assistant, September 2014 has issued the following statement....

2. “Codes 76000 or 76001 can be reported WHEN USED WITH OTHER SURGICAL PROCEDURE CODES, WHEN THERE IS NO SPECIFIC INSTRUCTION FORBIDDING THEIR USE IN CONJUNCTION WITH THE BASE CODE.”

  • For the last example let’s look at CPT codes 64561 and 64581. CPT code descriptor for 64561 reads – Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed. Based on what we learned in Part 1 fluoroscopy would be included in the base code or primary service. But if you look at the code descriptor for 64581 it reads – Incision for implantation of neurostimulator electrode array; sacral nerve (transforaminal placement). There is no reference made here for use of fluoroscopy and no other instructions that would preclude the use of code 76000 – therefore this CPT Assistant article specifically states that 76000 can be reported in addition to code 64581.

Just to reiterate, fluoroscopy code 76000 can be additionally reported with other surgical procedure codes as long as there isn’t a specific instruction forbidding its use. Just a few examples of when fluoroscopy is not reported;

  • When the physician is not present during the use of fluoroscopy
  • When fluoroscopy is included in a more comprehensive radiological procedure such as the RS&I codes (Radiological Supervision and Interpretation)
  • Although not stated in the code descriptors fluoroscopy is inclusive to ALL endoscopy procedures (arthroscopy, hysteroscopy, laparoscopy, cystoscopy, GI endoscopy services) unless there are specific instructions or parenthetical notes that allow reporting







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