Podiatry Coding & Billing Alert

Question: We have a podiatrist that visits patients in a nursing home. Can we bill a visit and a 76000 together? Are there any conditions that we should fulfil?

Tennessee Subscriber

Answer:  Yes. You can report visits with initial visit code 99306 (Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components:…) and subsequent visits from among codes 99307-99310. You can also bill for 76000 (Fluoroscopy [separate procedure], up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]). You may also report an anatomy-specific x-ray code if the fluoro machine creates a permanent image and there’s a formal report.

However, you should take care of supervision requirements for proper fluoro coding. The choice of radiological imaging guidance code is based on the procedures performed and documented in the medical record. Because fluoroscopic imaging requires personal supervision, you should not report a fluoroscopic code if the physician is not present in the operating room during a procedure that uses fluoroscopy or fluoroscopic guidance. However, the appropriate radiographic code to report the anatomy evaluated should be submitted in the event that a) the radiologist’s contract with the hospital requires that a radiologist issue a formal interpretation, or b) the physician performing the study requests that a radiologist produce a formal report of the procedure from permanent images recorded.

You can submit code 76000 when fluoroscopy is the only imaging performed. For example, a patient presents to the radiology department with a prior joint x-ray series demonstrating a calcified body near the joint. The physician uses fluoroscopy with the joint flexed, extended, and rotated to determine whether the calcification is indeed loose within the joint. Because fluoroscopy is the only imaging procedure performed at that patient encounter, you will only submit code 76000 once (not for each joint position examined). 

Another example is when there is no other fluoroscopy code that more accurately describes the imaging performed (i.e., codes 77001-77003, Fluoroscopic guidance…). For example, a patient steps on a needle, and fluoroscopy (C-arm) is used to assist the physician to locate and remove this foreign body from the skin wound. In this instance, if C-arm fluoroscopic imaging is being provided without a diagnostic radiologic examination (i.e., no hard copy record of the images is produced), then code 76000 should be used to identify the imaging procedure provided. Because code 76000 is designated as a separate procedure, modifier 59 (Distinct procedural service) or one of the new EPSU modifiers should be appended and reported in addition to the appropriate codes from the integumentary system section.

You should also attach the appropriate diagnosis codes to their highest specificity to justify the medical necessity of the procedure.