Orthopedic Coding Alert

Tyler Wesland, RN, of Sangemente, CA, is just one of several readers who wrote to ask how to get paid for fluoroscopy (76000) during percutaneous pinning. Is a modifier needed to be reimbursed for this as an additional procedure? Which modifier and why? he asks.

Some payers might reimburse a small amount if you append the -26 modifier (professional component), but you would be coding inappropriatelynot to mention bordering on fraud and abuse.

In diagnostic radiology codes, such as 76000, that contain a technical and a professional component, modifier -26 represents the physicians work of supervising and interpreting the fluoroscopy, says Susan Callaway Stradley, CPC, CCS-P, senior consultant for the Medical Group of Elliott, Davis and Co., LLP, a healthcare accounting and consulting firm in Augusta, GA.

If you use modifier -26, auditors expect to find a separate, written report of the findings of the diagnostic procedure included in the documentation, says the winner of the American Academy of Professional Coders 1998 Coder of the Year Award. Its not enough to write a one-liner in the op report stating fluoroscopy was used, adds Stradley.

The CPT includes in its definition of code 76000 the words separate procedure, which means it is reported only when it is not an integral part of another procedure.

Remember, fluoroscopy is a diagnostic radiology code. According to the American Academy of Orthopedic Surgeons (AAOS), fluoroscopy used in surgical procedures is not considered diagnostic, and therefore should not be billed as a separate diagnostic procedure.

For example, in its Complete Global Service Data for Orthopedic Surgery, the AAOS lists intraoperative photos, video imaging and other imaging or monitoring equipment by operating surgeon or assistants as a generic intraoperative service that is bundled into the global service package when surgically indicated. In addition to 76000 (fluoroscopy), the AAOS says you should not bill separately for the following codes when they are part of a surgical procedure:

72240-72295 myelography and diskography

75685-75716 angiography

75820-75822 venography

76003 localized fluoroscopy

76080 radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation

95925-95927 short latency somatosensory evoked potential study

The AAOS takes a firm stance on this matter as this excerpt from their policy statement shows:

The AAOS believes it is unethical for orthopedic surgeons to separate from the global service packages services which are a necessary part of the surgical procedure and to then bill individually for those services.

Finally, fluoroscopy is, by CPT definition, part of percutaneous fracture treatment.

A percutaneous skeletal fixation is a type of fracture treatment in which fracture fragments are not viewed directly but rather via fluoroscope or x-ray in order to place the fixation across the fracture site, says Stradley. For example, codes such as 24538 (percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture) and 26608 (percutaneous skeletal fixation of metacarpal fracture, each bone) rely on fluoroscopy.