Wiki fluoroscopy - I have a billing quandrum

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ELWOOD18

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Good Day!!

I have a billing quandrum. :rolleyes: Our Podiatrist wishes to bill a fluoroscopy 76000 with surgical podiatry codes. One point of view is it is included in the surgical package. But when looked up in the CPT, there is no mention of the fluoroscopy in the code descriptor.

Can anyone shed some light on this please.....:D
 
It does make it a challenge for us when the CPT does not include the flouro with all CPT surgical codes descriptions. I explain to my surgeons that the 76000 is a "Separate Procedure" and thus it should only really be used when it is the only thing performed. So unless he is performing the fluoroscopy on a different anatomical area, we should not report it with a surgical code in the same area. I have copied a few paragraphs from some articles I have found here that may help clarify a situation:

The CPT surgery guidelines further state that the codes listed as “separate procedure“ should not be reported in addition to the code for the total procedure or service. In other words, report a separate procedure if it is not performed with a primary procedure that encompasses the “separate” one, or when it adds “appreciably to the time and/or complexity of the procedure.”

Medicare does not always incorporate the CPT “separate procedure“ codes into the NCCI edits, but rather assumes that the coder will recognize coding scenarios in which a procedure or procedures are an integral part of the progression to the end procedure and, therefore, may not be billed separately. Conversely, Medicare may incorporate a CPT “separate procedure” code into the NCCI and list it as a code that can never be unbundled — regardless of the scenario.

CMS definition: “If a CPT code descriptor includes the term separate procedure, the CPT code may not be reported separately with a related procedure.” CMS interprets this designation to prohibit the separate reporting of a separate procedure when performed with another procedure in an anatomically related region often through the same skin incision, orifice, or surgical approach.
http://anesthesiology.mckessonrevenews.com/index.php/archives/85-separate-procedure-in-cpt-coding

Whenever you are coding for procedures and services, it is important to consider the Medicare NCCI edits, the CPT-designated “separate procedure” codes, and those procedures services that are routinely viewed as an integral part of another more extensive procedure.
 
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