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Please help?

  1. #1
    Question Please help?
    Clearnace Sale
    When is it appropriate to use 76000? When is it appropriate to use the modifier 52 in radiology? Example: Surgeon takes patient to OR or Endoscopy suite and performs a procedure. During the surgery/procedure fluorosocopy is used but the Radiologist is not present. However, the films are sent to Radiology and a formal report is dictated by the Radiologist. The report and the films are then sent to the coders to code. We read the report and it says a single lateral view, fluoroscopy assistance, C-arm images show blah blah please see operative report for further details. Then we look at the films/pictures and it shows a fluoro picture, but it states ie spine cervical 2 or 3 views. Should we code 76000 for fluoro, or 72040 for the x-rays. Plus we are not sure what soft images or your hard images mean? Modifier 52 we are using when fluoroscopy assistance is provided to the surgeon via C-arm images when an -oscopy procedure is performed ie endoscopic catheterization of the biliary ductal system RS&I 74328. Is this correct? PLEASE HELP!

  2. #2
    76000 is meant for direct supervision. You have to be physically using it and present at the procedure to bill for it. There are a lot of uses for modifier 52 but in regards to what you are questioning 52 can be used on the S&I (supervision and interpretation) radiology codes (like 74328). The radiologist is not supervising (present) at the surgery but he is interpreting the images later on. He should report 74328/52. It splits in half, signifying that he interpreted the images, but wasn't supervising the surgery.
    There are a lot of procedures that produce images that don't have special S&I codes, like spinal surgeries. If the surgeon is using fluoroscopy (he should report 76000) and the radiologist is intrepreting images then he will use the code for how many views were taken of that anatomical region (like 72040). It sounds like there is a little discrepency between your report from the radiologist and the films you're looking at but I would code from the radiologist dictation. If he says 1 view, I would code for 1 view.
    P.S. not sure what the difference between soft images and hard images.

  3. #3
    Default 52 mod
    Modifier 52 Fact Sheet
    • Reduced Service reports a partially reduced or eliminated service or procedure.
    Appropriate Usage:

    Procedures for which services performed are significantly less than usually required may be billed with the “52" modifier.

    Report the service provided with modifier 52 and the appropriate reduced original charge.

    Services modified at the physician's discretion to be less than the usual procedure.

    When the documentation describing the service fully supports that the service furnished was less than usually required.
    Inappropriate Usage:

    Do not use for terminated procedures.

    Do not use for situations when the patient has the inability to pay the full charge.

    Do not use on a time-based code (i.e. anesthesia, psychotherapy or critical care).

    Do not report on Evaluation & Management and Consultations codes.
    Additional Information:

    Claims need to indicate “Documentation available upon request” in item 19 or the electronic equivalent.

    Reduce the amount you normally bill for the service(s) on your claim accordingly.

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