Intraoperative fluoroscopy


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Our orthopedic surgeons use fluoroscopy extensively while in the OR not only to fix fractures, but to check on hardware, check bone cortex and bone density and alignment, all kinds of things. Obviously soft tissue doesn't show up, but for anything involving bone, they use it. So, its such an integral part of what they do, and they do not produce any written report giving the fluoroscopic findings separate from the op note, I thought fluoroscopy could not be separately billed by the surgeon, plus in the descriptor for 76000 it says its a separate procedure, meaning its only billable if thats the only thing that was done during that session.
Ok, so another office is disputing this and billing 76000-26 unless its specifically not allowed in the NCCI. Its true some orthopedic procedures do not have 76000 in column 2, and some do. If its not in column 2, then it must be billed with modifier 26, but I see no evidence of our docs ever writing up a separate report for every time they employ the C-arm. What do you think?
You cannot bill for the fluoroscopy if it is integral to the other procedure(s). However, if it was used for a different issue, then you can bill for it. Sometimes you will need to use the 59 modifier, but if it is clearly being used for a different problem/area, then you would not have to use the modifier. I believe that is where column 2 comes into play b/c a modifier is not always necessary.
Here is an excerpt you can also refer to "Remember, fluoroscopy is a diagnostic radiology code. According to the American Academy of Orthopedic Surgeons (AAOS), fluoroscopy used in surgical procedures is not considered diagnostic, and therefore should not be billed as a separate diagnostic procedure."