Orthopedic Coding Alert

If you can't distinguish a spot film from a standard x-ray, read this

Orthopedic coders have to remember scores of coding rules, from fracture care to surgery coding to disease management. In addition, orthopedic practices face radiology coding challenges every day, because imaging is an integral part of good surgical care.

If you occasionally find radiology coding tricky, the answers to the following five questions may help you submit your claims with fewer headaches and better reimbursement odds. Look to NCCI for Intraoperative Imaging Guidelines Question 1: When is it appropriate to report interpretation of intraoperative images? And if we can bill these, what is the proper way to code these services? Answer 1: Under the National Correct Coding Initiative edits, fluoroscopy (76000, Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) is bundled into many orthopedic procedures. For example, fluoro is a component of 25565 (Closed treatment of radial and ulnar shaft fractures; with manipulation). When fluoro is defined as a Column 2 code, do not apply a modifier to override the NCCI edit unless the fluoro was performed during a separate encounter or on a separate part of the body.

If fluoro is not defined as part of the procedure (either by the CPT code definition or by the NCCI edits), you can report 76000 when the orthopedist supervises and interprets the fluoroscopy during an operative procedure. The physician must document that fluoro was used and what it revealed. Be sure to use modifier 26 (Professional component) if the fluoro was performed in the hospital setting.

If permanent x-ray images are captured (either on film or in a PACS system) for diagnostic purposes and these images are interpreted by the orthopedist, you can report the code for x-ray exam of the body area--for example, 73090 (Radiologic examination; forearm, two views). For example, a diagnostic x-ray exam would typically be performed at the conclusion of the surgery to confirm the result. If you charge for an x-ray interpretation, be sure the orthopedist has dictated an interpretive report.

Although the physician's interpretation can be included in the surgical op report, you must maintain complete documentation of the x-ray findings. According to the Medicare Claims Processing Manual, Chapter 13, Section 100.1, -A professional component billing based on a review of the findings . . . without a complete, written report similar to that which would be prepared by a specialist in the field, does not meet the conditions for separate payment of the service.-

Also, always remember to apply modifier 26 (Professional component) if the physician performs the service in a hospital setting.

Some professional organizations have stated their position on these services. For example, the American Society for [...]