Health Information Management

Q&A: Can we charge fluoroscopy during endomyocardial biopsies?

APCs Insider, May 16, 2014

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Q: Our physicians have started performing endomyocardial biopsies on an outpatient basis. They insert the catheters into the right ventricle using fluoroscopy. We have added the charge lines to our chargemaster and we are debating whether radiology can charge for the fluoroscopy. It is bundled into so much these days that we don’t know whether it can be charged.
 
A: Fluoroscopy, and most types of radiological guidance, are bundled into the main procedure code under the OPPS. The NCCI Manual actually has specific guidelines stating that the fluoroscopy is included in the biopsy and not separately reportable.
 
In addition, the placement of the catheters is also included in the biopsy unless a medically necessary right heart catheterization is performed, and the documentation supports that it is a distinct service from the biopsy. The NCCI Manual, Chapter 11, Section I.22 states:
 
Endomyocardial biopsy requires intravascular placement of catheters into the right ventricle under fluoroscopic guidance. Physicians should not separately report a right heart catheterization or selective vascular catheterization CPT code for placement of these catheters. A right heart catheterization CPT code may be separately reportable if it is a medically reasonable, necessary, and distinct service performed at the same or different patient encounter. Fluoroscopy codes (e.g., CPT codes 76000, 76001) are not separately reportable for an endomyocardial biopsy.
 
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman and founder of Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.



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