Wiki Is it appropriate to use 76000?

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Cheri CPC

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Hi,

If anyone can help me with this it would be so appreciated! I am doing some temporary work for an ortho surgeon who is routinely coding 76000 with operative procedures, he documents use of fluoro, but it is used to verify fracture alignment. I thought that that would be considered as integral to the procedure. But the more I keep researching I'm seeing this code used with modifier -59. In these cases there isn't a distinct procedure, merely confirming fracture is reduced, or pins placed at optimum spot etc. Is anyone else dealing with this?

Thanks for your help!
 
The June #104 Edgeblast has some info. on code 76000.
-jenn
 
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I've reviewed it, but it really doesn't give me the answer I'm looking for.... Thanks anyway, Jenn!
 
Cheri CPC said:
Hi,

If anyone can help me with this it would be so appreciated! I am doing some temporary work for an ortho surgeon who is routinely coding 76000 with operative procedures, he documents use of fluoro, but it is used to verify fracture alignment. I thought that that would be considered as integral to the procedure. But the more I keep researching I'm seeing this code used with modifier -59. In these cases there isn't a distinct procedure, merely confirming fracture is reduced, or pins placed at optimum spot etc. Is anyone else dealing with this?

Thanks for your help!
Click to expand...

I think it depends on the procedure if it's integral or not. If he is using it to verify fracture alignment that is a "separate procedure" and it would qualify. Look at the guidelines in the front under "separate procedures", to me it sounds like it may answer your question. Hope that helps. :)
 
Cheri:

76000 is not billable to the ortho surgeon during an operative procedure. If the procedure was done at an ASC or Hospital, they own the equipment, so the ortho doctor can not bill for the whole enchilada. Here is what they can bill for. They can bill for 76000 or 76001 with a 26 modifier as long as they report it separately and the hospital does not have the radiologist reading the films. This means the hospital or ASC has to agree.

_________
Cynthia Everlith BSHA, CPC
 
woo-hoo! I found the answer in writing! It is in EXTRA Supplement Issue of Orthopaedic Coding Alert Vol. 9 No. 9. References both ASSH and AAOS. Thanks for all of your responses, this was my first time asking for help here, and I had responses within hours,,, on a SUNDAY! Thanks!

Oh, and the answer is 76000 is bundled with many orthopaedic procedures, if 76000 is in column 2 do not bill unless on a different body part, so check NCCI edits (found on CMS website) and if not in column 2, it does get reported with modifier 26 if performed in hospital.
 
you may also want to look at codes 20985-20987, be sure to see the list of primary procedures that these can be billed with.
 
Can you use 77002 -26?

77002 "Includes all radiographic arthroscopy with the exception of supervision and interpretation for CT and MR arthrography."
 
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