General Surgery Coding Alert

General surgeons may use fluoroscopy with many procedures. The prospect of payment, however, depends on what the other procedure was and why the fluoroscopy was performed. One of the most confusing issues for general surgery coders involves the following two nonspecific fluoroscopy codes:

76000 Fluoroscopy (separate procedure), up to one hour physician time, other than 71023 or 71034 (e.g., cardiac fluoroscopy) 76003 Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device). Although 76000 and 76003 are nonspecific, they differ greatly, says Kathleen Mueller, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill. "You use 76003 for localizations, biopsies and other services involving needle placement when fluoroscopy is used," she says. "In some cases, surgeons may use fluoroscopy instead of ultrasound." Note: Ultrasonic guidance for needle placement is coded 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). General fluoroscopy (76003) often is performed for guidance instead of ultrasound. Code 76000 is generic and should be used only when no specific fluoroscopy code describes the procedure. "For example," Mueller says, "if the removal of a foreign body is performed under fluoroscopic guidance, 76000 would be the appropriate code because there is no specific code that describes this service."

Another important example involves the placement of a central venous catheter. This procedure, which is coded 36489 or 36533 depending on whether the catheter is "tunnelled" under the skin, often is performed under fluoroscopic guidance, but CPT does not include a specific fluoroscopy code for the service. CPT instructs surgeons who use imaging guidance with 36489 to report 76000, notes Linda Laghab, CPC, coding manager for Pediatric Management Group at Children's Hospital Los Angeles. "When reporting 76000, the surgeon need not dictate a separate radiology report. Instead, the use of fluoroscopy may be documented by including a sentence similar to the following: 'Under fluoroscopic guidance, the catheter was inserted, and the tip of the catheter is in good position,' " she says. New CCI Guidelines Until recently, Medicare had not issued any policies or instructions regarding the bundling of 76000 into vascular procedures. Version 7.3 of the Correct Coding Initiative (CCI), which became effective Oct. 1, 2001, however, included new guidelines that would restrict separate payment to only those nonroutine catheter placement or endoscopy procedures. According to Chapter 1 of the CCI, "placement of central access devices (central lines, pulmonary artery (PA) catheters, etc.) involves passage of catheters through central vessels and, in the case of PA catheters, through the right ventricle; additionally, these services often require the use of fluoroscopic support. Separate reporting of CPT codes for right heart catheterization, first order venous catheter placement or other services which [...]