Ob-Gyn Coding Alert

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) on the removal code 11982 (Removal, non-biodegradable drug delivery implant) is if he documented more than time (see CPT® guideline for use of 22).  If the time was only related to finding the device and not significant work in removing it, your request for additional reimbursement will probably get shot down (especially as you are already billing the 76000).