Ob-Gyn Coding Alert

Reader Question:

Fluoroscopy? Don't Bill for Ultrasound Guidance Too

Question: My ob-gyn’s notes state, "The patient’s Nexplanon was unable to be palpated for removal. Ultrasound did not help in locating it, so I had to use fluoroscopy. After several attempts in the OR, it was able to be removed. Procedure took 2 hours, certainly more than a normal removal." Can we bill for the fluoroscopy?  How do we code that?   Arkansas Subscriber Answer: Code 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) is the fluoroscopy code to use -- BUT the ob-gyn must have documented that there was a permanent image and also describe what he saw during the use of the fluoroscope.   Warning: You can’t bill in addition for ultrasound guidance since that failed and you moved on to a more "extensive" method. The only way you are going to qualify for a modifier 22 (Increased procedural services) [...]
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