Cardiology Coding Alert

Question: Should I refrain from using 71090 for fluoroscopy at the time of an ICD implant because the definition mentions only pacemakers?

Oregon Subscriber

Answer: Typically, you will report fluoroscopy at the time of ICD implant the same way you report fluoroscopy for pacemaker implants -- with 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation). Although 71090's definition mentions only pacemakers, the AMA confirms that this is the appropriate code to report for ICD implants as well.

Indeed, the AMA's CPT Assistant (August 2002) states that "CPT code 71090 ... is intended to be used with pacemakers or cardioverter-defibrillators."

Fluoro tip: Your physician will likely use fluoroscopy to visualize the leads' advancement into the appropriate location but won't always note this in the operative report. If you find that your physicians do not clearly document fluoroscopy, make sure you inform them that this is a separately billable and reimbursable service, but only if their operative reports support it.

In other words, if the term "fluoroscopic guidance" (or similar verbiage) is absent from your cardiologist's note, you should not bill it; you would not have the documentation necessary to support that service.

Code 71090 has a global, technical, and professional fee allowance. If the physician is billing for the professional component (modifier 26), you must have documentation available to support the test's supervision and interpretation. In that case, the hospital would bill the technical component (modifier TC) portion.