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Radiology coding help

  1. #1
    Default Radiology coding help
    Medical Coding Books
    We billed the following report as a 76000 and 77002 and was rejected for the 77002 by Medicare. I'm new to radiology coding so I have no idea if I can attach a 59 modifier to this claim. Can anyone take a look at this op note and explain this to me? ANY help would be greatly appreciated!!

    RIGHT HIP THERAPEUTIC INJECTION

    HISTORY: Right hip pain for several months. No trauma or
    fracture of the right hip.

    COMPARISON: MRI right hip 11/21/2011.

    FLUORO TIME: 8 seconds.

    FINDINGS: The risks, benefits, and potential complications were
    discussed with the patient including pain, infection, and
    bleeding. All questions were answered. Written and oral informed
    consent were obtained.

    The patient was positioned in the supine position. The femoral
    artery was palpated and marked. Fluoroscopy was used to identify
    the superolateral portion of the femoral neck. The overlying skin
    was marked and prepped and draped in sterile fashion. The patient
    was given subcutaneous 1% lidocaine with bicarbonate for local
    anesthesia.

    A 25 gauge spinal needle was advanced to the surface of the
    femoral neck and placement was confirmed with intra articular
    injection of 1 cc of contrast. A mixture of 3 cc Optiray 240, 3
    cc Marcaine, and 1 cc of 40 mg Depo-Medrol was injected into the
    hip joint.

    The spinal needle was removed and a bandage was applied. The
    patient tolerated the procedure without difficulty. There were no
    immediate postprocedure complications.

    The spot arthrographic images demonstrate degenerative change of
    the hip.

    PAIN LEVEL PRIOR TO INJECTION: 8

    PAIN LEVEL POST INJECTION: 0.5

    A 14 x 9 mm ossific density fragment is noted adjacent to the
    right acetabulum, which could represent a small fracture fragment
    or os acetabuli.

    IMPRESSION:
    1. IMPROVEMENT IN PATIENT'S RIGHT HIP PAIN FOLLOW INJECTION
    OF MARCAINE, DEPO-MEDROL SOLUTION.
    2. 15 X 9 MM OSSIFIC DENSITY FRAGMENT ADJACENT TO THE RIGHT
    ACETABULUM, WHICH COULD REPRESENT SMALL FRACTURE FRAGMENT VERSUS
    OS ACETABULI.

  2. #2
    Default
    Hi! What other codes did you bill with those?


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  3. #3
    Default
    76000 needs a 59 modifier to be billed with the 77002.

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    I am not seeing a 76000 documented to bill for, I see a 20610 and a 77002. Where did you get the 76000 from?

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    It looks like he's just doing a hip injection. He's using the contrast to make sure the med only hits the joint then he's injecting his med. I would have coded 20610- major joint (...was injected into the hip joint) , J1030 (40 mg Depo-Medrol) and 73525 (spot arthrographic images demonstrate degenerative change of the hip). 73525 would include 77002- so that wouldn't be billed and 76000 can't be used as a stand alone code if any other arthrography imaging is done.

    Fluoroscopy is considered a part of such procedures as gastrointestinal exams, arthrography, myelography, cholecystography, venography, angiography, arteriography and cystography and is not coded separately. A general rule of thumb is if fluoroscopy is always performed as part of the radiological imaging study, fluoroscopy is included in the radiologic procedure code.

    Also, CPT 77002 has higher RVU's than CPT 76000, so in any case with these two codes being billed together, CPT 76000 would get the 59 modifier, not 77002.

    Hope this helps!


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  6. #6
    Location
    Alexandria, LA
    Posts
    518
    Default
    This is 20610 and 77002.
    You can't bill 76000 because fluoro is included in 77002.
    You can't bill 73525 because this was not a formal, diagnostic arthrogram.

  7. Default 76000 is a col 2 CCI edit for 77002
    A general rule of thumb is if fluoroscopy is always performed as part of the radiological imaging study, fluoroscopy is included in the radiologic procedure code.

    CPT® fluoroscopy codes 76000 (up to 1 hour physician time) and 76001 (physician time greater than 1 hour) are intended for use as stand-alone codes when fluoroscopy is the only imaging performed. The most common scenarios include imaging that is not described by a separate supervision and interpretation (S&I) code and when a radiologist assists another physician in the performance of a procedure.

    (Reprinted from ACR Bulletin, March 2002)

    http://www.acr.org/Hidden/Economics/...opyCoding.aspx

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