FLUOROSCOPY IN THEHOSPITAL SETTING

Chapter 9 of the NCCI Policy Manual states, ?Providers/suppliers shall not report radiologic supervision and interpretation codes, radiologic guidance codes, or other radiology codes where the radiologic procedure isintegral to another procedure being performed at the same patient encounter. PTPedits that bundle these radiologic codes into the relevant procedure codes have modifier indicators of ?1?allowing use of NCCI PTP-associated modifiers to bypass them An NCCI PTP-associated modifier may be used to bypass such an edit if and only if the radiologic procedure is performed for a purpose unrelated to the procedure to which it is integral.?

Fluoroscopic and Spot Im ages in The Hospit al Set t ing

If a procedure code does not include fluoroscopy (either in its description or by NCCI edits), either the radiology department or the operating room (but not both) may report it separately Fluoroscopy code 76000 has a status indicator of Sunder OPPS, which means it is separately payable and not subject to multiple procedure discounts.

Many radiology departments report a charge for fluoroscopy as means to track the use of radiology resources in the operating room or surgical suite. However, this may result in account errors or denials if there is a conflict between the fluoroscopy code and other procedure codes reported on the same date of service. It is therefore recommended that the radiology department utilize a different method for tracking productivity relating to operating room services

When ?spot images?are taken fluoroscopically during a surgical procedure, the hospital should report a charge for these images using the appropriate CPT® code for a plain-film x-ray of the specific anatomic site being imaged If the same spot view is taken multiple times during an operative procedure, this does not equate to a multi-view study; the code for a single-view study should be reported when applicable. For example, three lateral images of the cervical spine taken during a spinal fusion surgery should be reported as a single-view exam (72020) as opposed to a three-view exam (72040)

Conclusion

Fluoroscopic imaging guidance is a vital component of many surgical and interventional procedures in the hospital setting. However, it is critical to ensure that the coding and billing for fluoroscopy complies with Medicare guidelines to avoid potential errors and financial penalties

Understanding the nuances of correct and compliant coding for both fluoroscopic imaging guidance can help ensure that healthcare providers are properly reimbursed for their services and can continue to provide quality care to their patients.