Radiology Coding Alert

Question: Where can I find a list of all the operating room procedures that are incidental with fluoroscopy codes 76000 and 76001? And where can I find guidelines for these fluoro codes? For example, I've heard that these codes reflect the amount of fluoro time rather than the case length or time the operating room books the unit.

Virginia Subscriber

Answer: The best place to start is the list of Correct Coding Initiative (CCI) edits available online at http://www.cms.hhs.gov/NationalCorrectCodInitEd/. You'll find both hospital and physician edits available for download.

You'll find plenty of edits for 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) and 76001 (Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrosto-lithotomy, ERCP, bronchoscopy, transbronchial biopsy]).

Important: When CCI lists fluoro as a Column 2 code, you should not append a modifier to override the edit unless the fluoro is for a separate encounter or on a separate body part. If CPT or CCI doesn't define fluoro as part of a procedure, you can report fluoro for a physician who supervises and interprets the fluoroscopy during an operative procedure.

The physician must document fluoro use and what it revealed. Be sure to use modifier 26 (Professional component) for physician coding for hospital procedures.

Time: CPT defines 76000 and 76001 in terms of physician time. The physician does not have to personally operate the fluoro machine, but he is required to supervise the technologist who is operating it and must interpret the images. The op report again should indicate fluoro use and findings.

If you're billing for the hospital, and the operating room (OR) isn't reporting the imaging services' technical component, you may do so as long as the documentation supports it. Just make certain that OR personnel are not capturing charges for these services so you don't "double-charge" the patient.

If the procedure has a specific imaging code, you should report the code most appropriate to the procedure performed, rather than fluoro.

Example: Report 75978 (Transluminal balloon angioplasty, venous [e.g., subclavian stenosis], radiological supervision and interpretation) for venous angioplasty imaging services.