Orthopedic Coding Alert

Question: Which code should we report if our surgeon interprets intraoperative fluoroscopy? He often uses fluoroscopic guidance during fracture surgeries and would like to collect for reading the results.

Pennsylvania Subscriber

Answer: Your question represents one of the many "gray areas" of coding, because the AMA (which governs CPT) has never issued specific guidance on this topic. In addition, some coding consultants disagree on whether you should bill for your surgeon's work interpreting fluoroscopic guidance in the OR.

The American Academy of Orthopaedic Surgeons (AAOS) generally advises that surgeons should bundle intraoperative fluoro into their surgical charges, because the physician performs fluoro as "integral" to the surgery.

So you might ask, "During which procedures is fluoro integral to the surgery?" You can check the AAOS' Global Service Data guide or the NCCI edits to determine whether those sources include fluoroscopy as "bundled" into the main procedure that your surgeon performed.

Some coding consultants believe that if a radiologist is not present in the OR and the surgeon has to personally interpret the fluoroscopy, then the surgeon should report 76000-26 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]; professional component).

If you decide to report 76000-26, you should ensure that NCCI doesn't bar you from reporting the codes together and that your insurer doesn't have a policy against billing this way. Some payers interpret the "separate procedure" statement in 76000's descriptor to mean that you can only bill 76000 if the fluoro interpretation is unrelated to the main surgery.

Because the AMA does not have a formal policy on this topic, you should contact your local carrier to determine its guidelines on intraoperative fluoroscopy. Keep in mind that 76000-26 pays about $8.71 (before being adjusted for geographical differences), so you can at least have the peace of mind that you won't be writing off too much reimbursement if your carrier does not allow you to report the code.