Wiki Billing 76000 with orthopedic procedures

[Lunap99]

I realize that 76000 is only coded if it is considered a separate procedure as imaging is usually included in the procedure package. If the code description does not specify, that imaging may be included, how would I know if it is? One example I am working on is
28750: Arthrodesis, great toe; metatarsophalangeal joint and
28285: Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)
These descriptions do not mention "with imaging when used" like some other codes do. There is a CCI edit that states "Code 76000 is a column 2 code for 28285, but you may use a CCI-associated modifier to override the edit under appropriate circumstances." So, how am I supposed to know if imaging is included in a code or not and if we can bill 76000-59-26?

 

[Orthocoderpgu]

So if fluro was used to perform 28285 per the NCCI edits, it would be considered bundled. If fluro was used for something else not related to 28285, then it would be billable. But speaking from reality, your not going to see that. Insurance companies also make up their own minds on 76000, so basically it can be very difficult to tell if an insurance will pay for it or not. So few pay for fluro, it's really not worth your time. You will spend more time working the denials making the few times it's paid not worth your while. Another thing that I have seen is insurance companies denying 76000 just because it hits an edit on the claim even though the fluro was not used for that procedure that it hits an edit with. Many ortho coders won't bill 76000 with ortho procedures because they consider it integral to performing the procedure. In my experience 76000 gets denied almost every single time, so it's not worth it to me to bill. Others may have a different experience.