Urology Coding Alert
Steer Clear of Reporting Fluoroscopic Guidance with Lithotripsy
Question: When my urologist performs an ESWL, is ultrasound guidance and/or fluoroscopy included? If not, can he bill the US guidance with 76998? New Hampshire Subscriber Answer: Yes, you can report 76998 (Ultrasonic guidance, intraoperative) with 50590 (Lithotripsy, extracorporeal shock wave) if your urologist uses ultrasound guidance. According to current Correct Coding Initiative (CCI) rules, the ultrasound is not included in the extracorporeal shock wave lithotripsy (ESWL) code and may be billed if medical necessity exists. Note: On the other hand, if your urologist only uses fluoroscopic guidance, you cannot report a separate code. The fluoroscopy is bundled into the ESWL and not separately billable.
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