Fluoroscopy code 76000 vs. x-ray code 73530

lmsnyfla

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Please help ! There is some confusion in my office regarding codes 76000 versus x-ray codes. Doctors use fluoroscopy/fluoroscopic guidance during surgical procedure. Some of the Doctors want the x-ray code billed and some say the 76000 should be billed. I say the x-ray code should be billed.. with a -26 modifier of course. Case in point: Dr performs manipulation under anesthesia of acetabulum with fluoroscopy. I would bill 27222 and 73530 -26. Suggestions welcome !!!!
 

zaida120

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I would not bill 27222 and 73530 with a 26 modifier. According to CCI edits Code 73530 is a component of Column 1 code 27222 and cannot be billed using any modifier.
In regards to billing 76000 with the surgical procedures I would first check the CCI edits. If it says you can bill in addition to primary CPT with a -59 modifier I would make sure that the op report clearly states that the flouro was done on a completely different body part. I would also be careful in billing x-rays with surgical procedures. X-rays are usually included in the surgical CPT code. Again check the CCI edits (http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage).
Here is an example:
Procedure: Closed manipulation and casting of right distal radius fracture with flouroscopy to assess alignment.
Code: 25605 (only).
Coding the flouorscopy would be considered unbundling. Coding the x-ray (73530) would be considered unbundling.

I hope this helps!
 

lmsnyfla

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Thanks for your input. I didn't even check the cci edits. The Doctors have me going crazy (go figure !)
 

mbort

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other codes you may want to consider are the codes for ortho that were new 01/08, code series 20985-20987. These are add on codes, be sure to check the primary procedure list (the 27222 is on it).

If you are not able to use one of the above, and the CCI edits allow it, then the 76000-26 is appropriate for the fluoroscopy. The ASC should be charging the TC component of the same ( at least the ones I code for do).

Hope this helps.
Mary
 

lmsnyfla

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Yes, it helps immensely ! I'm sorry for the delay in responding to you Mary. I didn't get on the website yesterday. I appreciate everyone's input !
 
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