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Question 63030 with 76000

athenan21

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Our neurosurgeon is including 76000 in his billing and everything I am reading says it is inclusive of the procedure. However, in Encoder Pro it says there is a modifier 59 applicable to 76000. Do you include the CPT or leave off?

After induction of anesthesia, the patient was rolled in the prone position on padded bolsters. Relevant pressure points were carefully inspected. The lumbar region was prepped and draped in the usual fashion. A localizing
x-ray was taken. The fascia was divided to the midline after skin incision, and the METRx endoscopic retraction system placed over the L4-L5 level. Its position was confirmed by AP and lateral fluoroscopy. The microscope was brought into position.

The diamond bur drill was used to remove the inferior aspect of the L4 lamina, and medial facet region. Ligamentum flavum was mobilized with a blunt nerve hook, and removed piecemeal with Kerrison instruments. The thecal sac and nerve were exposed.
The plane ventral to the shoulder region nerve root was developed with blunt nerve hook dissection. The area of large herniated disk, which was broad base was identified, and incised with the 15 blade. Disk material was removed with straight and angled
pituitary instruments. The deeper disk space had clearish fluid, not frank purulence, but very edematous and degenerated nuclear disk material. There was also free-floating cartilaginous endplate in association with this, particularly having been
dislodged from the inferior aspect of L4, and these fragments came out in unison with the disk material. More medial disk was mobilized downward in the disk space with dental instruments and Epstein curettes, and cleared with angled pituitary
instruments.

After these maneuvers, the thecal sac and nerve appeared lax and well decompressed. Hemostasis was obtained throughout. Bone edges were waxed. Hemostasis was obtained with the assistance of Surgiflo and Surgicel. Bone edges were waxed. The exposure
was copiously irrigated with antibiotic solution. A Hemovac drain was brought through a separate stab incision and secured to the skin. The skin was infiltrated with local anesthetic. The wound was closed with layers of Vicryl with staples in the skin
surface, given her general medical issues and liver failure. A sterile dressing was applied.
 
8. Fluoroscopy reported as CPT code 76000 is integral to many procedures including, but not limited, to most spinal, endoscopic, and injection procedures and shall not be reported separately. For some of these procedures, there are separate fluoroscopic guidance codes which may be reported separately

6. Fluoroscopy reported as CPT code 76000 shall not be reported with spinal procedures, unless there is a specific CPT Professional codebook instruction indicating that it is separately reportable. For some spinal procedures, there are specific radiologic guidance codes to report in lieu of these fluoroscopy codes. For other spinal procedures, fluoroscopy is used in lieu of a more traditional intraoperative radiologic examination which is included in the operative procedure. For other spinal procedure codes, fluoroscopy is integral to the procedure

Further, the CPT has (separate procedure) designation. See the beginning of the surgery section in the CPT book for the definition.
The reason it shows a 59 "might" be allowed is if it was separate, distinct, or unrelated to the other procedure.

The NCCI edit is "standards of medical surgical practice" take a look at the NCCI Manual here for that definition.
B. Coding Based on Standards of Medical/Surgical Practice https://www.cms.gov/files/document/01-chapter1-ncci-medicare-policy-manual-2026-final.pdf
 
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