Orthopedic Coding Alert

According to CMS'physician utilization data, orthopedic surgeons reported the fluoroscopy codes 76001 (Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephros-tolithotomy, ERCP, bronchoscopy, transbronchial biopsy) and 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) far less frequently than they reported 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) and 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 neurolyt-ic agent destruction).

Although several factors (such as your patient base, subspecialty, geographic region, etc.) affect which codes you ultimately report, if you bill 76001 significantly more often than you report 76000, you may be confusing the two codes.

To determine whether you report fluoroscopy services more or less frequently than other orthopedic surgeons do, you should "benchmark" your code use against CMS national averages, many coding consultants say.

The following chart demonstrates how many fluoroscopy claims CMS processed for orthopedic surgeons in 2001 (the most recent year for which data are available). CMS notes whether the procedure is performed in a facility (such as a hospital) or non-facility (such as a physician practice) and whether any modifiers are appended to the claims.

Please note that this information is based on Medicare data only, and therefore may not reflect the full spectrum of an orthopedic practice's patients, who are usually covered by various insurers (Medicare, Medicaid, private insurers, workers'compensation, etc.)

Source for raw data: "1997-2001 Procedure Code Utilization by Specialty," available on the CMS Web site at www.cms.gov/physicians/pfs.