Neurosurgery Coding Alert

When your neurosurgeon uses her mini C-arm device to take x-rays, you probably have quite a few questions on how to code the procedure. If you take the guesswork out of coding for these services, you can submit your claims for these services faster and more accurately.

We-ve contacted the experts to give you an update with the most current information available about coding and billing for radiology claims.

Practices that don't have radiology techs on staff may purchase mini C-arm machines to use on-site. This device is a small fluoroscopic imaging machine that surgeons often use in the operating room to take real-time images of a patient's extremities. But providers can also use the device to take standard x-ray views.

The problem: When should coders report x-ray codes, and when are the fluoro codes more applicable?

The solution: If you are storing the images on film or in a PACS system permanently, you can report the regular x-ray exam codes (e.g., 72220, Radiologic examination, sacrum and coccyx, minimum of two views), says Jackie Miller, RHIA, CPC, senior coding consultant at Coding Strategies Inc. in Powder Springs, Ga. The x-ray codes require that you store permanent images.

If you use the C-arm to view the anatomy without taking permanent images, you should instead report 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]), assuming you aren't just taking a "quick look" but are instead using the C-arm for a medically necessary reason to evaluate joint motion or structure, Miller says.

Unfortunately, discerning coding and billing rules is difficult when you-re reporting intraoperative imaging.

In the American Academy of Orthopaedic Surgeons (AAOS) book Complete Global Service Data for Orthopaedic Surgery, under items included in the global package, item number 6 states that the global package always excludes ionizing radiation. On the other hand, number 7 states that the global package includes intraoperative supervision and positioning of imaging and/or monitoring equipment by the operating surgeon or assistant.

The question: These items seem to contradict each other. If the physician uses fluoro, is it included in the global package or not?

The official word: We contacted Robert Haralson, MD, medical director at the AAOS, who said, "Our position is that fluoroscopy is billable if permanent films are made and the physician dictates and signs the -official- report that goes in the hospital chart. Most hospitals require that a radiologist do that, so unless the orthopedist wants to get involved in a long, laborious and usually unsuccessful effort to be credentialed to be the one that can generate the official report, it is not worth the effort.

"Where it is worth it is in the ASC where there are no radiologists," he says.

If your surgeon uses fluoroscopic guidance on several different sites during the same surgery, you should not report multiple units of 76000.

You should report a single unit of 76000, regardless of the number of sites the physician addresses. This is because the physician sets up the guidance system once, so he does not expend additional significant work when he uses the guidance on more than one site. In addition, 76000 is a time-based code, reported just once for one hour of physician time.