Radiology Coding Alert

Question: Our doctor performs a fluoroscopic "sniff" test for evaluation of the diaphragmatic motion. We bill procedure CPT 76000 for the reports, but most insurance companies will not pay this. How should I code this for optimal reimbursement?

Georgia Subscriber Answer: If the radiologist produced no films, you must report 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]), even if your insurance company won't pay.

If the procedure produced a two-view chest radiographic exam along with the fluoroscopic test, report 71023 (Radiologic examination, chest, two views, frontal and lateral; with fluoroscopy). If you have four views, report 71034 (Radiologic examination, chest, complete, minimum of four views; with fluoroscopy).

The sniff test involves fluoroscopy of the diaphragm while the patient sniffs to test for paralysis of the diaphragm. The failure of the insurance company to reimburse you may stem from the diagnosis code you pair it with. Your most likely option is ICD-9 code 519.4 (Disorders of diaphragm), so check with your payer to see if that code will yield reimbursement. But remember, you can only report the documented diagnosis.