Radiology Coding Alert

Question: I have documentation that indicates the provider performed fluoroscopy for 1 hour and 30 minutes. We originally assigned 76000 and 76001 to report the procedure, but the claim was denied.

How should we correct the claim?

Nevada Subscriber

Answer: You’ll assign 76000 (Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time) and append the CPT^® code with modifier 22 (Increased procedural services), according to the September 2019 CPT^® Assistant. Code 76000 is designated for up to 60 minutes of fluoroscopy. Modifier 22 allows you to report a fluoroscopy session that lasts beyond the first hour. Be sure to check payer policy for individual reporting preferences, such as reporting multiple units instead.

CPT^® code 76001 (Fluoroscopy, physician or other qualified health care professional time more than 1 hour, assisting a nonradiologic physician or other qualified health care professional (eg, nephrostolithotomy, ercp, bronchoscopy, transbronchial biopsy)) was deleted on Jan. 1, 2019, which is most likely why your claim is being denied.

During fluoroscopy, the provider passes a continuous X-ray beam through the body to visualize the patient’s internal body structures. The provider can view the images on a monitor, so the physician can evaluate the structures in real time.

Code 76000’s descriptor indicates the procedure can be performed separately, but if a related procedure includes an imaging service, such as 33274 (Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed), then you shouldn’t report 76000 in conjunction with the primary procedure code. On the other hand, if the physician performs 76000 with an unrelated procedure, then you may report the fluoroscopy code appended with modifier 59 (Distinct procedural service).