Neurosurgery Coding Alert

Neurosurgeons use fluoroscopic imaging for a variety of surgical and diagnostic procedures. Recognizing how to apply the available fluoroscopy codes and understanding bundling issues raised by national Correct Coding Initiative (CCI) edits will improve your claims' accuracy and minimize denials. Get to Know the Codes Fluoroscopy is a type of x-ray that transmits constant, real-time images of the selected body area(s). The images provide an advantage to the surgeon attempting to pinpoint an exact anatomic location or track the movement of instruments, for instance during injection procedures or delicate surgical interventions. CPT includes four codes to describe this process:
  76000 Fluoroscopy (separate procedure), up to one hour physician time, other than 71023 or 71034 (e.g., cardiac fluoroscopy)
76001 Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician (e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)
76003 Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device)
76005 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint), including neurolytic agent destruction. Codes 76000 and 76001 are nonspecific and apply only when a more precise code is not available to describe the service provided, says Jan Rasmussen, CPC, president of Professional Coding Solutions, an Eau Claire, Wis.-based consulting firm. For example, the surgeon may use fluoroscopic imaging during spinal (e.g., 22520, Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) or cranial surgery (e.g., tumor resection 61548, Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic). Note that these codes are time-based and that 76001 is not an add-on code. Rather, it describes physician time of more than one hour you should not report 76001 more than once per session while 76000 describes physician time up to one hour. Therefore, if the physician spends 45 minutes, 76000 is appropriate. If the physician spends one hour 15 minutes, 76001 is correct. If the physician spends two hours 10 minutes, 76001 alone is still appropriate, and so on. 76003 and 76005 Add Specificity Code 76003 is more exact than either 76000 or 76001 in that it describes fluoroscopy used for needle placement only, such as during therapeutic injection for treatment of carpal tunnel syndrome (e.g., 20526, Injection, therapeutic [e.g., local anesthetic, corticosteroid], carpal tunnel) or during aspiration procedures (e.g., 62268*, Percutaneous aspiration, spinal cord cyst or syrinx). CPT introduced 76005 in 2000 to describe imaging during nerve blocks, e.g., diagnostic or therapeutic facet joint injections 64470-64476, Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve, and epidurals 64479-64484, Injection, anesthetic agent and/or steroid, transforaminal epidural, [...]