Wiki 76000 with use of 26 modifier

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GraceW

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OK I work for an ortho surgeon. When he does certain surgical procedures where he has to use fluro to check fixation, etc. he has me bill the fx code along with 76000 (fluro code) but add the 26 modifier to the fluro to tell the insurance this is for his READING the films to assure proper placement, etc. Insurances are denying stating it is inclusive to the surgical procedure. According to the Code X program I use through the AAOS I see where this denies as incidential but I am confused as to the use of the 26 modifier as that is for the reading. I have added a 59 modifier also with the 26 and sometimes can get certain carriers to pay this but I am nervous about the fact that 59 may be the wrong modifier. Can I bill 76000 with the 26 modifer? In my appeals I am telling the insurance this is for the surgeon to READ the films and not do the actual positiioning, taking the
x-rays etc.

Thanks for any input.
 
76000

Hi Grace,

Here is a description of the correct usage of 76000 below.

A radiologist or other qualified health care provider supplies separate fluoroscopic monitoring of the body for up to one hour for procedures that do not include fluoroscopy as an integral component. This code is reported separately to describe the professional work component entailed in providing fluoroscopic monitoring. If formal contrast x-ray studies are done and included as a part of the procedure to produce films with written interpretation and report, fluoroscopy is already included and cannot be separately reported.

You can use -26 modifier with this CPT, the issue is the primary procedure you are 1st billing for & in most cases it is inclusive & isn't separately payable. Notice as I said payable not billable you can bill it, but again in most cases insurance payers won't reimburse for it.

I've been a radiology coder for 20+ years & we don't even bill these to payers anymore as they are rarely paid. I hope this helps.

Renee
 
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