# Radiology coding help



## dnm4345 (Jan 6, 2012)

We billed the following report as a 76000 and 77002 and was rejected for the 77002 by Medicare. I'm new to radiology coding so I have no idea if I can attach a 59 modifier to this claim. Can anyone take a look at this op note and explain this to me? ANY help would be greatly appreciated!!

RIGHT HIP THERAPEUTIC INJECTION

HISTORY:  Right hip pain for several months.  No trauma or
fracture of the right hip.  

COMPARISON:  MRI right hip 11/21/2011.  

FLUORO TIME:  8 seconds.  

FINDINGS:  The risks, benefits, and potential complications were
discussed with the patient including pain, infection, and
bleeding. All questions were answered. Written and oral informed
consent were obtained.

The patient was positioned in the supine position. The femoral
artery was palpated and marked. Fluoroscopy was used to identify
the superolateral portion of the femoral neck. The overlying skin
was marked and prepped and draped in sterile fashion. The patient
was given subcutaneous 1% lidocaine with bicarbonate for local
anesthesia. 

A 25 gauge spinal needle was advanced to the surface of the
femoral neck and placement was confirmed with intra articular
injection of 1 cc of contrast. A mixture of 3 cc Optiray 240,  3
cc Marcaine, and 1 cc of 40 mg Depo-Medrol was injected into the
hip joint. 

The spinal needle was removed and a bandage was applied. The
patient tolerated the procedure without difficulty. There were no
immediate postprocedure complications. 

The spot arthrographic images demonstrate degenerative change of
the hip.

PAIN LEVEL PRIOR TO INJECTION: 8

PAIN LEVEL POST INJECTION: 0.5 

A 14 x 9 mm ossific density fragment is noted adjacent to the
right acetabulum, which could represent a small fracture fragment
or os acetabuli.   

IMPRESSION:
1.     IMPROVEMENT IN PATIENT'S RIGHT HIP PAIN FOLLOW INJECTION
OF MARCAINE, DEPO-MEDROL SOLUTION.  
2. 15 X 9 MM OSSIFIC DENSITY FRAGMENT ADJACENT TO THE RIGHT
ACETABULUM, WHICH COULD REPRESENT SMALL FRACTURE FRAGMENT VERSUS
OS ACETABULI.


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## BABS37 (Jan 6, 2012)

Hi! What other codes did you bill with those?


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## jgf-CPC (Jan 6, 2012)

76000 needs a 59 modifier to be billed with the 77002.


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## mitchellde (Jan 6, 2012)

I am not seeing a 76000 documented to bill for, I see a 20610 and a 77002.  Where did you get the 76000 from?


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## BABS37 (Jan 6, 2012)

It looks like he's just doing a hip injection. He's using the contrast to make sure the med only hits the joint then he's injecting his med. I would have coded 20610- major joint (...was injected into the hip joint) , J1030 (40 mg Depo-Medrol) and 73525 (spot arthrographic images demonstrate degenerative change of the hip). 73525 would include 77002- so that wouldn't be billed and 76000 can't be used as a stand alone code if any other arthrography imaging is done. 

Fluoroscopy is considered a part of such procedures as gastrointestinal exams, arthrography, myelography, cholecystography, venography, angiography, arteriography and cystography and is not coded separately. A general rule of thumb is if fluoroscopy is always performed as part of the radiological imaging study, fluoroscopy is included in the radiologic procedure code. 

Also, CPT 77002 has higher RVU's than CPT 76000, so in any case with these two codes being billed together, CPT 76000 would get the 59 modifier, not 77002. 

Hope this helps!


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## donnajrichmond (Jan 6, 2012)

This is 20610 and 77002. 
You can't bill 76000 because fluoro is included in 77002. 
You can't bill 73525 because this was not a formal, diagnostic arthrogram.


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## MaryMoore (Jan 9, 2012)

*76000 is a col 2 CCI edit for 77002*

A general rule of thumb is if fluoroscopy is always performed as part of the radiological imaging study, fluoroscopy is included in the radiologic procedure code. 

CPT® fluoroscopy codes 76000 (up to 1 hour physician time) and 76001 (physician time greater than 1 hour) are intended for use as stand-alone codes when fluoroscopy is the only imaging performed. The most common scenarios include imaging that is not described by a separate supervision and interpretation (S&I) code and when a radiologist assists another physician in the performance of a procedure. 

(Reprinted from ACR Bulletin, March 2002) 

http://www.acr.org/Hidden/Economics...hives/JanFeb09/UpdateonFluoroscopyCoding.aspx


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