# Fluroscopy - Would someone share their



## stockekt (Jul 28, 2014)

Would someone share their documentation requirements for Fluroscopy?  Our physician is injecting the contrast and interpreting the image.  I'm trying to convince him that a separate report is needed.  Please help.  Thank you!


----------



## Kelly_Mayumi (Jul 29, 2014)

Have you checked bundling edits on fluroscopy to see if it's even reportable seperately?  Last I checked and per NCCI, fluroscopy is not seperately reportable with an endoscopic service.  While you're question doesn't mention when the fluroscopy is being used, it sounds to me like it might be used during an endoscopy?


----------



## stockekt (Jul 31, 2014)

Procedure:  Cystoscopy with Right retrograde pyelogram
                 Left ureteroscopy with laser lithotripsy
                 Left ureteroscopy with stone basket extraction
                 Placement of a left 6-French double J Stent


Below is the use of the fluoroscopy:

Retrograde Pyelogram:  A right retrograde ureteropyelogram was preformed.  A 6 Fr open ended catheter was introduced into the right ureteral orifice without difficulty.  Contrast was instilled while fluoroscopy was performed.  The ureter was normal cliber without filling defect.  The intrarenal collecting system had an unremarkable configuration and no evidence of hydronephrosis.  Prior to contrast instillation, no right renal stones could be indentified on fluoroscopy.

Does this help?


----------



## nateich (Jul 31, 2014)

I would code this as 52356 LT and 74420-26; the op note should have a separate paragraph with findings of the retrograde in order to be billed. I did receive this info from AUA PMN coding seminar in 2013. Essentially, a separate report is not necessary.


----------



## Kelly_Mayumi (Aug 1, 2014)

I agree, this is 74420, 26.


----------



## deeplocica (Aug 13, 2014)

*reimbursement issues for 74420, 26*

We have always billed 74420, 26 Mod for this service.  No separate note should be necessary, as it was done as a part of the main procedure.  However it must be documented clearly in the notes.

Is anyone having a reimbursement issue for this code?  Beginning in May, Medicaid is stating the Radiologist and the surgeon cannot both bill for this code on the same date of service.  Even with the 26 modifier.  I'm confused as this has never been an issue inthe past.  So far it looks like Medicaid is the only one who has changed their reimbursement policy.  But I haven't been able to confirm with them the exact change.

Thanks!!


----------



## Kelly_Mayumi (Aug 15, 2014)

deeplocica- I have noticed this change also.


----------



## kjenkinstx21 (Aug 18, 2014)

*Fluroscopy*

The coding companion states that you should only use 76000 when fluoroscopy is not considered an integral part of the procedure. I was under the impression that all cystoscopic procedures required fluro. 

I concur. I have seen an increase of use of 76000 within the last week or two. I wonder if the physicians received something from AUA or Urology Today regarding fluoroscopy. Thank you!

Respectfully,
K Songer, CPC-A, CUC


----------

