Health Information Management

Q&A: Coding for inpatient computer-assisted fluoroscopy

JustCoding News: Inpatient, January 18, 2012

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QUESTION: I have a question regarding the coding of a computer-assisted fluoroscopy.

Consider the following documentation:

Use and interpretation of intraoperative fluoroscopy. After positioning the patient, the posterior lumbar area was prepped and draped in the standard sterile fashion. The prior incision was marked with a marking pen. C-arm fluoroscopy was used to map an incision extending from the tip of the spinous process of L2 to that of L5.

After performing a time-out, this incision was infiltrated with local anesthetic and incised with a 10-blade scalpel. Dissection proceeded through the subcutaneous fat using Bovie monopolar cautery. Self-retaining retractors were applied. Dissection then proceeded in the midline through the avascular plane through the lumbodorsal fascia and musculature using the Bovie. Self-retaining retractors were deepened.

Would you assign a procedure code for the fluoroscopy for this inpatient procedure or would it just be inclusive in the procedure? There seems to be confusion when comparing this procedure in an inpatient setting vs. an outpatient setting.

ANSWER: Great question! You are correct that the code assignment for procedures such as computer-assisted fluoroscopy can be quite different depending on setting. In CPT®, there are currently add-on codes in the category III codes (0054T–0055T) to identify computer-assisted musculoskeletal orthopedic procedures using either fluoroscopy or CT/MRI.

Recognition and payment for category III codes may vary by payer since they are considered new and emerging technology codes. Per CPT Assistant, June 2011, each category III code is used for five years from initial publication and is given a “sunset date” or a scheduled deletion/archived date. Based on the most recent CPT (2012 version), these two codes are identified as scheduled to “sunset” in January 2014. After this date, they will either be assigned a permanent code in the Category I codes or will have to be reported with an unlisted code for the service.

However, for acute inpatient facility coding, we will use ICD-9-CM Volume 3 procedure codes. Per the American Hospital Association’s Coding Clinic, fourth quarter, 2004, new code category 00.3x (effective October 1, 2004) was added to identify computer-assisted surgeries (CAS). Use of such modalities like CT/CTA (procedure code 00.31), MR/MRA (procedure code 00.32), fluoroscopy (procedure code 00.33), and even imageless CAS (procedure code 00.34) were assigned specific codes.

Although the reporting of such procedures will not impact the overall MS-DRG assigned, they can however assist in data collection by hospitals as well as payers to identify the use of computer technology and its value in producing positive outcomes versus a traditional operative procedure that doesn’t use such technology. Use of CAS has become increasingly common in brain, spinal, ENT (ear, nose, and throat) and orthopedic procedures, for which precision and accuracy is paramount.

In this scenario, you would assign procedure code 00.33 for the use of the CAS fluoroscopy and additional code(s) for the diagnostic or therapeutic procedure.

Editor’s note: Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding at HCPro, Inc., in Danvers, MA, answered this question. E-mail questions to Managing Editor Doreen Bentley.

This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

Need expert coding advice? Submit your question to Managing Editor Doreen Bentley, CPC-A, and we’ll do our best to get an answer for you.

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