Anesthesia Coding Alert

Take these 4 steps to get 76005 claims paid If you're suddenly facing a flood of denials for fluoroscopy claims, you're not alone. Before you give up or attempt to use modifier -26 (Professional component) to circumvent another fluoroscopy bundle, follow these four  steps to get your pain management specialist's fluoroscopy claims paid. Step 1: Be Sure You Use the Correct Fluoro Code Most fluoroscopy services performed by anesthesiologists or pain management specialists fall under code 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction). However, don't automatically rule out CPT's three other fluoroscopy codes: 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]), 76001 (Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]) and 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]).
 
Before you use 76005, be sure that one of the other codes doesn't apply instead. Most pain management specialists don't have the clinical situations to report 76000 or 76003, says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver, but it never hurts to be sure. Step 2: Verify Whether Edits Apply Verify whether the applicable fluoroscopy code is subject to any NCCI (National Correct Coding Initiative) edits or bundles. Hammer says 76000 and 76003 are bundled with most codes, but that shouldn't affect pain specialists much because 76005 is the correct code for spinal injections or procedures.
  
And that's where the problem with 76005 denials appears. Some commercial carriers - such as Blue Cross and Champus - and some workers' compensation plans  are suddenly denying claims with 76005 despite the addition of modifier -26 to unbundle the codes. And while some coders say they've had reimbursement problems since CPT 2000 added 76005, many believe the trend seems to be on the upswing.
 
This new trend potentially means big losses to the physician's bottom line because fluoroscopy is so common. "My clients perform some type of radiologic verification for the vast majority (about 95 percent) of all spinal procedures," Hammer says. "The only exception is 62273* (Injection, epidural, of blood or clot patch).
 
"Reimbursement for Colorado RBRVS 2003 for 76005-26 is $28.51, and the fee schedule for workers' compensation for Colorado is $64.48. These denials really do affect the bottom line because of the large percentage of injections performed with fluoroscopy." (Of course your reimbursement baseline varies depending on your local factors and your carrier contracts.) Step 3: Learn How to Handle the Bundles NCCI edits earlier this year [...]