Wiki Surgeon Coding from 70000 series

[jifnif]

Let me start with saying that I used to code for radiology and now for multi-specialty which includes surgeons. I am having a hard time with figuring out why our surgeons are billing from the 70000 series. I believe one of the physicians does have his own ultrasound and bills for using it but what about fluoro? Here is a copy of a report that clearly DOES NOT state anything about fluoro and our doc billed and got denied. Always gets denied. Still insists that he should be paid for it. Am I missing something here in the surgeon's realm of things?
Preoperative Diagnosis:
1. Need for vascular access.

2. Invasive ductal carcinoma left breast.
Procedure:
1. Attempted insertion of vascular port via right cephalic vein.

2. Insertion of vascular port via right subclavian vein.
Specimen:
1. None.
Findings:
1. Cephalic vein never visualized.

2. Right subclavian vein utilized.
Drain: None
Surgeon:
Assistant:
Anesthesia: Local/TIVA
Postoperative Diagnosis:
1. Same.
EBL: Minimal
Complications: None
Patient Condition:
Stable. Patient tolerated procedure well and was taken to SSSU in stable condition.

 

[FTessaBartels]

Fluoro

Our surgeons will sometimes use fluoro and, if appropriate and documented, we will bill it. It is almost always denied and we rarely appeal those denials.

BUT .. the more important issue for you is how can this surgeon think s/he can be reimbursed for something s/he doesn't even document as being done?

I do not think you are missing anything. Stick to your guns. If the surgeon feels s/he should be billing separately for fluoro, then s/he MUST document it.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[MCook]

Also keep in mind, that you have to use modifier 26 if you do not own the equipment.

Michelle Bodisch, CPC