I work for a payer, and I have an op report that includes "fluoroscopic exam under anesthesia of left foot," and "fluoroscopic exam under anesthesia of left knee" as well as left knee aspiration. The fluoro exams were coded with 2 units of 76496 -26-59 (unlisted fluoroscopic procedure). The patient was also having surgical repair of a *right* foot fracture so he was under anesthesia for that.

In the report it states "We began at the left foot, AP, oblique and lateral fluoroscopic images were obtained. No acute fractures were noted." Then later "We then continued with fluoroscopic examination under anesthesia of the left knee. Radiographs were taken, fluoroscopic images. No fractures, aside from what we had previously evaluated were seen."

The other procedure billed for the left knee is 20610-59.

My question: is 76496 the appropriate code, and
Is it correct to bill the fluoroscopy separately from 20610 in this case, or is it included?

They used modifier 59 for 76496 but at least one of the fluoroscopic procedures was for the left knee which is where they did the aspiration.

Any help will be appreciated!