Health Information Management

Q/A: Billing for fluoroscopy

APCs Insider, August 31, 2012

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Q:  We continually get requests from our billing office to change the fluoroscopy charges on our central line procedures. We have had this panel set up for years and it hasn’t been a problem in the past.  However, they want us to remove our charge for fluoroscopy (76000) and report a new line item that they have set up.  We have gotten nowhere with trying to explain that this code represents fluoroscopy, but they just won’t listen.  Which code should we be reporting?

A:  Several years ago, fluoroscopy was represented by two CPT® codes:
  • 76000, fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]
  • 76001, fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrosto-lithotomy, ERCP, bronchoscopy, transbronchial biopsy]
These were the only codes available to report the service.  The charge line that you reference was probably created during that time and would have been the appropriate line item to report.   
However, since that time, CPT has added several codes for reporting fluoroscopic guidance depending on the procedure that is being performed. CPT code 77001 is specifically for reporting fluoroscopy utilized during the placement, replacement, or removal of a central venous access device.  The NCCI Manual narrative instructions (chapter 1 – General coding principles) note:
 Since CPT code 77001 describes fluoroscopic guidance for central venous access device procedures, CPT codes for more general fluoroscopy (e.g., 76000, 76001, 77002) should not be reported separately. 
Be sure to read the full code description for 77001, as this code includes radiological documentation of final catheter position.
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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