# Using a C-ARM intraoperatively



## kimt (Jun 11, 2009)

My facility is both a Clinic & has an ASC associated to it. When the surgeon is performing such procedures as removal of hardware, ORIF, ect. The are taking images and we are trying to figure out if we can bill the Radiology views? AHIMA & ACR state that a C-ARM is billable with radiology codes. AAOS states: “intraoperative supervision & positioning of imaging  and/or monitoring equipment by operating surgeon or assistant.” is included in such procedures. 

Is this billable? Is this being paid? Should I only be billing the TC component?

Any help is appreacited as I am just racking my brain on this one.

Thanks
Kim


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## JMeggett (Jun 11, 2009)

We have an ASC and it's our understanding that if the C-arm is being used to determine if the arthroscopic instrument is in the right location, or if needle is in right location...in order to complete the procedure, then the radiology code does not appy. It's bundled.  But if our Facility actually keeps a hard-copy of the Xray in the patients chart, then it is billable.  

Jenna Meggett, CPC, ACS-EM


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## kimt (Jun 12, 2009)

Our facility uses it for both purposes. In this case we are talking about using it to take Xrays and ensure all hardware is removed or placement in correct. So if have "hardcopy" (using the term loosely as nothing is hardcopy anymore it's all computer) of the xray we can bill the radiology?


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## JMeggett (Jun 15, 2009)

I can only suggest calling your insurance carrier on that one and asking whether they will cover in that scenario. We were specifically told that we need to keep a "hardcopy" of the xray in order to bill for C-Arm.  Literally an old-fashioned xray/film that stays in the patient's chart.  That unless that happens the C-Arm would be inclusive to the procedure.


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## mbort (Jun 15, 2009)

As an ASC, you can bill for the technical component (TC) for x-rays/c-arm/fluoro IF the radiology CPT code does not bundle with the procedure codes being performed.  Its very important to check the CCI edits.

Medicare/Medicaid will NOT pay for those codes that have the N1 payment indicator, I file those with the GY modifier for hopeful 2ndary carrier payment purposes.

Physicians may bill the radiology codes with the -26 modifier providing their documentation supports the supervision/interpretation portion of the code.

Also for ASC's...keep in mind...this is contract driven.  If your contracts dont include the radiology codes, then you wont get paid.

Hope this helps,
Mary, CPC, COSC


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