Orthopedic Coding Alert

Experts tackle fluoroscopy and x-ray coding challenges

If your mini C-arm device gets more use than your x-ray machine, you probably have quite a few questions on how to code when the surgeon uses the mini C-arm to take x-ray images. We can help take the guesswork out of coding for these services so you can submit your claims faster and more accurately.

Our April 2006 guest column, -Expert Answers to Your Top-5 Radiology Coding Questions,- generated many reader responses asking for more information about coding and billing for radiology claims. We-ve contacted the experts to give you a radiology coding update with the most current information available.

Report X-Ray Code if Mini C-Arm Stores Images

Orthopedic practices that don't have radiology techs on staff may purchase mini C-arm machines to use on-site. This device is a small fluoroscopic imaging machine that surgeons often use in the operating room to take real-time images of a patient's extremities. However, the device can also be used to take standard x-ray views.

The problem: After our bonus issue on radiology coding premiered, coders and surgeons wrote to Orthopedic Coding Alert asking for confirmation of when they should report x-ray codes and when fluoro codes are more applicable when using the mini C-arm.

The solution: If you are storing the images on film or in a PACS system permanently, you can report the regular x-ray exam codes (for example, 72220, Radiologic examination, sacrum and coccyx, minimum of two views), says Jackie Miller, RHIA, CPC, senior coding consultant at Coding Strategies Inc. in Powder Springs, Ga., and the author of our April 2006 guest column. The x-ray codes require that you store permanent images.

If you use the C-arm to view the anatomy without taking permanent images, you should instead report 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]), assuming you aren't just taking a -quick look,- but are instead using the C-arm for a medically necessary reason to evaluate joint motion or structure, Miller says.

Nail Down When Intraoperative Imaging Is Billable

Several physicians wrote to Orthopedic Coding Alert regarding intraoperative imaging.

One surgeon wrote, -In the American Academy of Orthopaedic Surgeons (AAOS) book Complete Global Service Data for Orthopaedic Surgery, under items included in the global package, item number 6 states that the global package always excludes ionizing radiation; however, number 7 states that the global package includes intraoperative supervision and positioning of imaging and/or monitoring equipment by the operating surgeon or assistant. These seem to contradict each other. If the physician uses fluoro, is it included in the global package or not?-

The official word: We contacted Robert Haralson, MD, MBA, medical director at the AAOS, who said, -Our position is that fluoroscopy is billable if permanent films are made and the physician dictates and signs the -official- report that goes in the hospital chart. Most hospitals require that a radiologist do that, so unless the orthopedist wants to get involved in a long, laborious and usually unsuccessful effort to be credentialed to be the one that can generate the official report, it is not worth the effort. Where it is worth it is in the ASC where there are no radiologists.-

Report a Single Fluoroscopy Code

If your surgeon uses fluoroscopic guidance on several different sites during the same surgery, you should not report multiple units of 76000.

You should report a single unit of 76000, regardless of the number of sites the physician addresses. This is because the physician sets up the guidance system once, so he does not expend additional significant work when he uses the guidance on more than one site. In addition, 76000 is a time-based code, reported just once for one hour of physician time.