Health Information Management

Q&A: How should we code fluoroscopy for outpatient procedures?

APCs Insider, March 1, 2013

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Q: Our physicians use fluoroscopy for many procedures and we have always reported the procedure and CPT® code 76001 (fluoroscopy, physician or other qualified healthcare professional tome more than one hour, assisting a non-radiologic physician or other qualified healthcare professional). Our claims are not passing through our scrubber and we get a message stating CPT 76001 is not reportable on a hospital outpatient claim. Since we are doing the procedure, what code should we be reporting?

A: CMS assigned CPT 76001 to status indicator B because fluoroscopy is integral to many films and procedures, especially with so many codes being changed to include the radiology modalities in the procedure definition.
 
Status Indicator B means the code cannot be reported under OPPS, but it also means that an alternate code may exist that is reportable under the OPPS. Depending on the procedure the physician performs, you should first look at the long description for the procedure code to insure that it does not include the radiology guidance and imaging. If it doesn’t, then the type of guidance that is documented may be reported with another code.  
 
The National Correct Coding Initiative Manual, Chapter 9, effective January 1, 2013, states:
 
Fluoroscopy is inherent in many radiological supervision and interpretation procedures. Unless specifically noted, fluoroscopy necessary to complete a radiologic procedure and obtain the necessary permanent radiographic record is included in the radiologic procedure and should not be reported separately.
 
Fluoroscopy reported as CPT codes 76000 or 76001 is integral to many procedures including, but not limited, to most spinal, endoscopic, and injection procedures and should not be reported separately. For some of these procedures, there are separate fluoroscopic guidance codes which may be reported separately.
 
Radiological supervision and interpretation codes include all radiological services necessary to complete the service. CPT codes for fluoroscopy/fluoroscopic guidance (e.g., 76000, 76001, 77002, 77003) or ultrasound/ultrasound guidance (e.g., 76942, 76998) should not be reported separately.
 
Radiological guidance procedures include all radiological services necessary to complete the procedure. CPT codes for fluoroscopy (e.g., 76000, 76001) should not be reported separately with a fluoroscopic guidance procedure. CPT codes for ultrasound (e.g., 76998) should not be reported separately with an ultrasound guidance procedure. A limited or localized follow-up computed tomography study (CPT code 76380) should not be reported separately with a computed tomography guidance procedure.
 
Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.



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