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radiology guidance and coding

  1. #1
    Location
    Greeley, Colorado
    Posts
    2,045
    Question radiology guidance and coding
    Medical Coding Books
    When urology uses US guidance for placement of fiducial markers; or when ortho uses fluoro guidance for injections don't the doctors that actually used the guidance code for that? Why would a radiologist code for it when he/she is not there at the time of the procedure? Are they required to read the "film"? If so, why would they report the guidance code? I don't think the radiologist should be charging anything for these films. I would like to hear other thoughts and opinions please...
    Lisa Bledsoe, CPC, CPMA

  2. #2
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Lisa, when our rehab doctors use fluoro for guidance on the spine injections, they always bill it, with the 26 modifier, since it's hospital equipment. The radiologist is not reading that - fluoro is "real-time", so unless that radiologist is in the room, I don't see how they could bill! I don't have any urologists - but similarly, my hepatologist uses ultrasound guidance for needle biopsies, as do the endocrinologists - they bill the U/S (with a 26 if done at the hospital, without for the thyroid since usually done in the office), and there is no radiologist charge. Again, this is done in real-time and there's nothing sent to a radiologist to view/interpret. How are they getting the charges to bill out? Just from the hospital?
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
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    Cindy - it's a strange situation. These procedures are done in our clinic, but in an area leased to the hospital (so they own the equipment and bill technical). The urologist, orthopedic surgeon AND the radiologist are "employed" by our clinic. The urologist or ortho will do the procedure in the radiology suite leased to the hospital. I guess (cuz I don't know for sure) that the radiologists for some reason view every "film" taken; even those from the real-time procedures. So they then are coding for the professional component even though they didn't do it, but they provided a little blurb of a report. I have gone rounds on this issue with administration and can't seem to get my point across that there is no need for a report (and certainly no charge!) from the radiologist when, like you said, it is a real-time guidance procedure. I am just really frustrated at this point. BTW - our docs code for themselves and I have to clean up the mess...
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Lisa, this is a real "AARGH"!! So do they not let the uro and ortho docs bill for it? If the docs are production-based, they could really have an issue here. And, if both are billing, an even bigger one! Good luck with this - you can tell them of at least one large practice (over 200 docs) that doesn't have the radiologists bill for fluoro and U/S readings when done with procedures, as the doc doing the procedure bills it out.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Yes it is a real AARRGGHHH!! They are paid on production and both uro/ortho and radiologists are coding, so one inevitably gets deinied (duh). Somehow the radiologists get their charges in faster. Truly one hand does not know what the other hand is doing or should or shouldn't be doing and they don't listen to me!! Do you have radiologists?
    Lisa Bledsoe, CPC, CPMA

  6. #6
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    I don't have any radiologists - there is one huge group of them in our city, and they are independent of both health systems, have priviliges at both. But they never bill for the U/S or fluoro done with surgeries - probably because our hospitals don't have them do it. We never have a problem with them - other than some of our other docs wanting to bill an interp when they pull the MRI up on Centricity, even though the radiologist has already done a report. I think I finally got through to them that it goes toward medical decision making when they personally view, but they can't bill separately for it!!

    Good luck with them!
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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