Radiology Coding Alert

The AMA speaks up on a common -- but tricky -- scenarioCPT offers you plenty of fluoroscopy codes, but if your radiologist is seldom in the operating room performing the fluoro, what do you do? Here's the scoop on what the authorities have to say.The rule: A lot of experts tell you that to charge a fluoroscopy code for your radiologist, the radiologist must be present and perform the imaging, says Missie Snyder, CPC, CPC-H, collection specialist with Financial Data Management in Santa Ana, Calif. But Snyder points out that the smart move is to find authoritative guidance to back up your coding.Size Up the CPT StandpointThe AMA, which publishes CPT codes, has offered you authoritative support for this rule. "Because fluoroscopic imaging requires personal supervision, a fluoroscopic code should not be submitted if the physician is not present in the operating room [OR] during a procedure that uses fluoroscopy or fluoroscopic guidance," states the AMA's July 2008 CPT Assistant.This position matches the recommendations the American College of Radiology (ACR) has been offering for years.Snag: Often the radiologist isn't present and only sees one or two films taken in the OR during the fluoro-guided procedure, and you have to decide how to code.What to do: If the radiologist/hospital contract requires the radiologist to give a formal interpretation, you may report the appropriate x-ray code based on the area the radiologist evaluates, CPT Assistant states. Or if the physician who provides the study asks the radiologist for a formal report from permanent images, you also may report an x-ray code based on the radiologist's documentation.Example: You code for a hospital-based radiologist and get the following report findings: Portable C-arm examination of the lumbar spine demonstrates needle positioned at the level of the L5 vertebra for epidural injection and pain management.Key: The radiologist only performed the film reading -- nothing else.Answer: Because the radiologist is not present and does not perform the fluoro, you should report the plain one-view film code (72020-26, Radiologic examination, spine, single view, specify level; Professional component), says Snyder.