Neurosurgery Coding Alert

Question: Under what circumstances may our surgeon code for fluoroscopic guidance?

Illinois Subscriber

Answer: In the vast majority of cases, your surgeon would not code to receive reimbursement for fluoroscopic imaging in the operating room.

The American Academy of Orthopaedic Surgeons (AAOS) has offered the advice that a physician may bill fluoroscopy "if permanent films are made and the physician dictates and signs the -official- report that goes in the hospital chart." However, most hospitals require that a radiologist perform these duties.

Unless your surgeon is credentialed to generate the official report (a long and perhaps unworthy effort), a staff radiologist -- rather than your surgeon -- will consistently claim the appropriate fluoroscopy guidance.

Note: In the ambulatory surgery center (ASC), your surgeon may be able to claim the fluoroscopy, but neurosurgeons perform few procedures in an ASC.

Remember, in addition, that if your surgeon does claim a guidance service, such as 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]), you should append modifier 26 (Professional component) to indicate that he provided only the "physician" portion of the service (that is, the surgeon did not supply the equipment and staff time necessary to perform the test).

Note that you would report a single unit of 76000, regardless of the number of sites the physician addresses.