Wiki fluoroscopic code 20985?

[peporter]

Hello coders, is the following fluoroscopic guidance with x-rays something I should be billing for the surgeon? The surgery was 3-part wrist fracture open reduction 25609. Is this documention adequate to bill either 20985 or 20986? Anyone getting these codes paid? Insurance is Medicare. Thanks again, Paula

A reduction maneuver was completed and the K-wires placed in the radial styloid near the shaft. The small locking plate by Synthes was then placed on the distal radius. One 2.7 fully-threaded cortical screw was placed in the
oblong hole in the shaft after drilling and measuring.
Next 2 distal locking screws were placed in using a locking guide and
drilling, measuring an appropriate sized length. While this was being
completed I held the reduction manually. Once this was done, I removed the K-wire and took x-rays under fluoroscopy. Fluoroscopy revealed that there was anatomic alignment of the fracture with the articular surface reduced and good position of the hardware. I then filled the remainder
of the distal locking screws after drilling and measuring for the
appropriate size length and then filled the additional fully threaded
cortical screw in the shaft of the plate. Final x-rays were taken.There was good position of the hardware with anatomic reduction of the
articular surface of the distal radius. I did have to complete a
reduced and good position of the hardware.

 

[steps2codes]

description of 20985 per ingenix
The key components of CAS include planning, registration, and navigation. Planning typically includes preoperative and/or intraoperative images taken by computed tomography, magnetic resonance, and/or fluoroscopy, and involves the creation of three-dimensional graphic models of the patient's anatomy.
is this what the physician did? or just the good old fluoro?

 

[mbort]

Paula,

the 20985 is an add on code and has a list of primary procedures. The 25609 is not on the list of primary codes, so no, it would not be appropriate to bill it. I do not believe Medicare will reimburse for fluoro (76000-26), or at least I havent had any luck getting it paid.

Also...the 76000 bundles with the 25609 so it would not be billable anyhow.

Mary

 

[peporter]

Thanks Angelica and Mary for your help. Angelica, the only documentation I had was what he indicated in the op note. So do you mean he would have images taken before surgery to compare to? It was hard to read your question highlighted in yellow. Mary recently mentioned those codes to me and I was just wondering if my surgeon documented something billable. He uses the fluoroscope often to check fracture alignment. Thanks again, Paula

 

[mbort]

For the case above, it appears to be straight fluoroscopy.

Here is the lay description for 20985 to give you a better understanding.

Computer-assisted surgery (CAS) is an adjunct process used in conjunction with certain orthopedic procedures. CAS encompasses both image-guided and imageless forms. Utilizing such tools as imaging, markers, reference frames, intraoperative sensing, and computer workstations, computer-assisted navigational procedures increase visualization of the surgical field and aid in precise navigation with minimally invasive approaches. CAS may involve guidance based on intraoperative images obtained by such means as fluoroscopy or ultrasound. It may also involve preoperative images or imageless navigation utilizing angles and measurements (kinematics) for anatomy determination. The key components of CAS include planning, registration, and navigation. Planning typically includes preoperative and/or intraoperative images taken by computed tomography, magnetic resonance, and/or fluoroscopy, and involves the creation of three-dimensional graphic models of the patient's anatomy. The patient-specific surgical plan and images are then used during surgery to guide the surgeon by combining these with intraoperative navigation capabilities. Optical targets, or trackers, such as digitizing or LED-equipped probes, are attached to points on the bone anatomy or to surgical tools. An optical camera tracks the position of these for accurate navigation and measurement in relation to any bone or instrument movement as the surgery is performed. The software in these navigational systems matches or "registers" the position of the patient on the operating table to the geometric description of the bony surface derived from the images already used to plan the surgery. Multiple images are simultaneously displayed on the monitor. The "virtual" tool trajectory that corresponds to the tracked tool movements is displayed over the previously saved views in real-time as the surgeon operates. Report 20985 for imageless CAS, 20986 for CAS with image guidance based on images obtained intraoperatively, and 20987 for those obtained preoperatively.~ ~~. ~~