Wiki 50590 and 76000

[toria11]

When is it ever appropriate to bill these two together? If using fluoroscopy to position the patient for the ESWL, it would be included, correct?

 

[daniel]

According to the latest Correct Coding Initiative edits, code 76000 (Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time) is bundled into code 50590 (Lithotripsy, extracorporeal shock wave) as an integral part of the procedure. You can potentially “break” the coding edit by appending a modifier to 76000 if you have sufficient documentation to support reporting both codes. In most situations, however, you should submit only 50590 alone.

 

[toria11]

According to the latest Correct Coding Initiative edits, code 76000 (Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time) is bundled into code 50590 (Lithotripsy, extracorporeal shock wave) as an integral part of the procedure. You can potentially “break” the coding edit by appending a modifier to 76000 if you have sufficient documentation to support reporting both codes. In most situations, however, you should submit only 50590 alone.

Hi! I did see this info. I'm just wondering in what situations and what would need to be in the documentation to support breaking the bundle.

 

[daniel]

If it was unrelated, I'd review the definition of modifier 59.

Modifier 59 is used appropriately for different anatomic sites during the same encounter only when procedures, which are not ordinarily performed or encountered on the same day, are performed on different organs, or different anatomic regions, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ.

Which would be a odd scenario found with 76000 + 50590. Could happen, but unlikely. I'd present this to provider, if they're the ones giving push back. And explain the definition of modifier 59.

hope this helps.