Wiki Add on code +77001 for fluoroscopic guidance

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plarabee

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I have a general surgeon who is using the add-on code for fluoroscopic guidance when he is inserting a central access device. He is adding the code to the primary procedure. A radiologist is doing an interpretation and report. The director of coding is saying the surgeon cannot use this code because the radiologist is performing it. I am so confused right now and would really like to hear what others are doing in these situations. Help!
 
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I have not a 10 year veteran with CPT coding, so my answer may be wrong, but I have always thought when they use fluoroscopy for guidance during a procedure and as long as the code does not include it, you can use it as an add on code? Unless, are you saying the radiologist is performing the fluoroscopy while the surgeon is inserting the central access device??? If that is the case, I can see why the surgeon would not be able to report it as he did not perform that part himself.

What code are you guys using for your primary procedure code?
 
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If the surgeon is performing the fluoro, you should bill 77001 -26 to indicate he performed the fluoroscopy.
We used to insert tunneled IVPACs all the time with fluoro using 77001 -26. I'll note that I never have seen a radiologist do an interpretation and report on these. For guidance during a procedure, typically the surgeon needs to look/view/assess while doing the procedure. A report even an hour later does not help placement. From my experience in these, the radiologist never performed the procedure, always the surgeon.
 
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Also agree with csperoni's response. I have seen instances where a radiologist will "overread" and issue a report later in the day because the facility has a requirement that any study with films/images be read by a radiologist. I've also seen facilities where the radiologist just issued a report of "images obtained by Dr. ____ during ____ procedure and stored in PACS as a courtesy" to navigate those facility requirements. In either case, though, an overread does not support the "supervision" component of radiology supervision & interpretation required to bill the 77001 with modifier 26. Whoever is in the room with the patient supervising/interpreting in real-time to guide placement (typically the surgeon) should report the code.

Kim
www.codingmastery.com
 
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