“Can I bill for using intraoperative fluoroscopy (C-arm) to assist in hardware placement before, during and after the procedure? The images are all taken while in the operating room. If so, do I need a modifier for the code? Can I use the same CPT for the surgery with the code for the intraoperative x-ray or does it require a different CPT code? Thank you!”
If fluoroscopy is used intraoperatively with the assumption being that the procedure is being performed in a hospital operating room or in an Ambulatory Surgical Center, the correct CPT code to bill is CPT 76000 which is defined as the following: Fluoroscopy (separate procedure), up to 1 hour physician time.
From a documentation standpoint, a written report needs to be provided that clearly and concisely documents all of the pertinent findings to support the professional component and there must be copies, either hard copy or electronic, of the views that were obtained to not only demonstrate that the studies were performed, but also to support the technical component of the CPT code that is billed.
As far as the coding is concerned, this can be interesting. Since the fluoroscope is owned by the facility, the provider cannot bill for the technical component. Obviously, the global package of the radiological study (technical component + professional component) cannot be billed either. If the facility has a contract with a radiology group to interpret ALL of the radiological studies that are performed within the facility, unfortunately that means that the provider that performed the procedure can bill nothing. However, if the facility does not have an agreement with a radiological group to interpret ALL of the radiological studies that are performed within the facility, then the provider can bill for the professional component of the fluoroscopic intraoperative study in the following fashion: CPT 76000 – RT/LT, 26. The 26 modifier is defined as the following: PROFESSIONAL COMPONENT ONLY – Use this modifier when you are only billing for the physician component of a service such as X-rays.
The CPT code for the procedure that was performed would be billed in addition to the CPT code for the intraoperative fluoroscopy. A different CPT code is not required.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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ADDENDUM:
To provide clarity to my statement last week regarding the article that was published in last week’s TLD Systems Newsletter, “Recurrent IPK And Treatment,” my goal is not to dictate or to instruct regarding how to treat a given scenario, but rather it is to opine on the coding issues that were presented.
With respect to the comment that I made regarding an “IPK being precancerous,”
typically, they develop beneath one or more lateral metatarsal heads or under another area of pressure under a bony prominence. Although the diagnosis of IPK is made clinically, the differential diagnosis includes plantar verrucous carcinoma and epidermal inclusion cyst.
This should provide a more concise, clear statement.
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