Medicare Compliance & Reimbursement

Question: When, on the same date, the radiologist places a central venous access device using fluoroscopy and then several hours later interprets a chest X-ray for the same patient because of breathing issues, may I report both the fluoro and the X-ray?

Answer: Yes, you may report a chest X-ray performed later in the day in addition to fluoroscopy performed for a distinct reason earlier in the day.

Example: For the device placement service, you report the fluoro (+77001, Fluoroscopic guidance for central venous access device placement, replacement [catheter only or complete], or removal [includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position] [List separately in addition to code for primary procedure]) as well as the code for the device placement. Then for the X-ray, you report the appropriate code, such as 71010 (Radiologic examination, chest; single view, frontal) and append modifier 59 (Distinct procedural service) to indicate the distinct nature of the service.

Linking the X-ray to the documented respiratory diagnosis, such as 518.5 (Pulmonary insufficiency following trauma and surgery), will also help support your claim for separate payment.

Beware: If the radiologist performs the X-ray to confirm device placement, you should report only the fluoro because +77001's descriptor includes "radiographic documentation of final catheter position."