How to Get Paid for Imaging Services Performed in Surgery John Marshall CRA, RCC, RT(R), FAHRA john-marshall@smh.com Disclaimer John Marshall, his wife Adrienne and their dog Shakespeare, specifically disclaim liability or responsibility for the results or consequences of any actions taken in reliance on anything in this presentation or the accompanying materials. We also apologize for any and all embarrassing remarks that come out of John s mouth during this presentation. The information provided in this presentation is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, policies, and payment amounts. All content in this presentation is informational only, general in nature and does not cover all situations or all payers rules and policies. This content is not intended to instruct hospitals and/or physicians on how to use or bill for healthcare procedures including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that is assumed to have been made prior to assigning codes or requesting payments. Hospitals and physicians should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing and payment levels for healthcare procedures. This presentation represents no promise or guarantee concerning levels of reimbursement, payment, coding, billing and coverage issues. Today s s Agenda: Getting Paid Regulations and Obstacles Turf Battles and Politics Fluoroscopy and RS&I Real-Life Examples Solutions and Options
GIVE US BACK OUR SURGERY CHARGES!
How to Get Paid for Imaging Services Performed in Surgery John Marshall CRA, RCC, RT(R), FAHRA john-marshall@smh.com Executives and the BOD Bottom Line Radiologic Technologist FTE/UOS
AR Days Patient Account Biller Regulations and Obstacles 2008 HOPPS Packaging Policies Image Processing Radiopharmaceuticals and Contrast Media Supervision & Interpretation Services Guidance Intra-Operative Services
Packaged Interoperative Services Services provided in support of other dependent minor procedures or diagnostic testing. Intravascular US Follow-Up Angiography Operative Hip Thyroid Met Uptake Operative Cholangiogram Wall Motion Add-On Ejection Fraction Add-On First Pass Add-On Bundling Versus Packaging Bundling Coding Term Applied to Sub-Components Not Reported Separately Packaging Financial Term Reimbursed Elsewhere Reported Separately Packaged Services MUST Be Reported! We encourage hospitals to report all charges for all services on claims for data on which the relative weights are set. This will insure the accurate reporting of the relative costs for all services. Fed Reg, Volume 68 #216 Nov. 7, 2003, Pg 63425
Yes, the Hospital still gets reimbursed. Gall Bladder 2007 $4,499 + $107 Cholangiogram 2009 $6,366 Includes all charges Hip Pinning 2007 $10,625 + Fluoroscopy + $76 OR Hip 2009 $11,346 Includes all charges Turf Battles Component Coding Surgical Procedures Require Component Coding Anesthesia Surgeon Operating Room Time = Procedure Code Imaging RS&I Procedures Drugs and Contrast Implantable Supplies
Billing Issues Surgical Component RS&I Component NCCI Edits Bundling Packaging Operating Statistic = Minutes and Levels (soft codes) Imaging Statistic = Units of Service (cpt) Professional Fee: Radiologist versus Surgeon Suggested Compromise Performing Physician Reports RS&I Operating Room Reports Surgical Codes Imaging Reports RS&I Codes (70000 series) Statistical Charges for NCCI Substitution Consider Additional Hour Statistics FLUOROSCOPY
ACR Guidance on Fluoroscopy Fluoroscopy is considered a part of such procedures as gastrointestinal exams - arthrography myelography - cholecystography venography - angiography arteriography - cystography and is not coded separately. AMA Guidance Radiologic supervision and interpretation codes for specific procedures include all the radiologic services necessary for that procedure. For example, do not additionally report fluoroscopy (e.g., CPT codes 76000, 76001, 77002, 77003) or ultrasound guidance (e.g., CPT codes 76942, 76998)." CPT Assistant, February 2007 National Correct Coding Initiative NCCI Manual, Chapter 9 "Unless specifically noted, fluoroscopy necessary to complete a procedure and obtain the necessary permanent radiographic record is included in the major procedure and should not be reported separately."
Fluoroscopy 76000 Fluoroscopy (separate procedure), up to one hour physician time Designated as a separate procedure Status T Inherent in all RS&I codes Reported when fluoroscopy is the only imaging performed and no radiographs produced Subject to NCCI Edits With Other Procedures 1001 1021 1031 1041 1201 1241 19201 19221 19241 19251 19261 19301 29900 29901 29902 29904 29905 29906 43648 43651 43652 1261 1401 1421 1441 1451 1471 19311 19321 19331 19351 19361 19511 29907 31231 31233 31235 31237 31238 43761 43770 43771 1481 1601 1621 1641 1701 1721 19521 19581 0195T1 19601 19611 19621 31239 31240 31254 31255 31256 31267 44180 44186 44187 1741 1761 1901 1921 2101 2111 19631 19651 19661 19671 19681 19691 31276 31287 31288 31290 31291 31292 44205 44206 44207 2121 2141 2151 2161 2181 2201 19901 19911 19921 10021 11042 11043 31293 31294 31505 31510 31511 31512 44212 44227 44360 2221 3001 3201 3221 3261 3501 19030 19296 19297 19298 20206 20220 31513 31515 31520 31525 31526 31527 44365 44366 44369 3521 4001 4021 4041 4061 4101 20500 20501 20526 20550 20551 20552 31528 31529 31530 31531 31535 31536 44376 44377 44378 4501 4521 4541 4701 4721 4741 20553 20600 20605 20610 20612 20670 31540 31541 31545 31546 31560 31561 44383 44385 44386 5001 5201 5221 5241 5281 5291 20680 20694 20696 20697 20902 20956 31570 31571 31575 31576 31577 31578 44391 44392 44393 5301 5321 5341 5371 5391 5401 20957 20982 20985 21116 22010 22015 31579 31615 31622 31623 31624 31625 45300 45303 45305 5411 5421 5461 5481 0054T1 5501 22100 22101 22102 22110 22112 22114 31626 31628 31629 31630 31631 31635 45315 45317 45320 0055T 5601 5611 5621 5631 5661 22206 22207 22210 22212 22214 22220 31636 31638 31640 31641 31643 31645 45331 45332 45333 5671 5801 6001 6041 6201 6221 22222 22224 22305 22310 22315 22318 31646 31656 31715 32550 32601 32602 45338 45339 45340 6251 6261 6301 6321 6341 6351 22319 22325 22326 22327 22505 22520 32603 32604 32605 32606 32650 32651 45355 45378 45379 6401 6701 7001 7021 7301 7401 22521 22523 22524 22532 22533 22548 32652 32653 32654 32655 32656 32657 45383 45384 45385 7501 7521 7541 7561 0075T1 7701 22554 22556 22558 22590 22595 22600 32658 32659 32660 32661 32662 32663 45392 45395 45397 0078T 7901 7921 7941 7961 7971 22610 22612 22630 22800 22802 22804 32664 32665 32997 32998 33202 33203 46604 46606 46608 8001 8021 0080T 8101 8201 8301 22808 22810 22812 22818 22819 22830 33206 33207 33208 33210 33211 33214 46614 46615 47370 8321 8341 8361 8401 8421 8441 22842 22849 22850 22851 22852 22855 33215 33216 33217 33218 33220 33224 47382 47500 47505 8461 8481 8511 8601 8621 8641 22856 22857 22861 22862 22864 22865 33225 33226 33234 33235 33243 33244 47554 47555 47556 8651 8661 8681 8701 8721 8731 23350 24149 24220 24435 24500 24516 33249 33265 33266 33508 33880 33881 47563 47564 47570 8801 8821 9021 9041 9061 9081 24685 25246 25447 25565 25600 25605 33883 33886 33967 34800 34802 34803 49320 49321 49322 9101 9121 9141 9161 9181 9201 25606 25607 25608 25609 25651 25652 34804 34805 34806 34808 34820 34825 49400 49411 49423 9211 9221 9241 9261 9281 9301 25671 25800 26010 26185 26356 26426 34830 34831 34832 34833 34834 34900 49441 49442 49446 9321 9341 9361 9381 9401 9421 26432 26525 26541 26546 26551 26553 36002 36005 36147 36475 36478 36481 49460 49650 49651 9441 9481 9501 9521 11121 11201 26554 26555 26556 26608 26615 26665 36555 36556 36557 36558 36560 36561 49655 49656 49657 11301 11401 11501 11601 11701 11731 26725 26727 26735 26742 26746 26860 36563 36565 36566 36568 36569 36570 50386 50387 50389 11801 11901 12001 12021 12101 12121 27036 27093 27095 27096 27130 27138 36571 36575 36576 36578 36580 36581 50398 50541 50542 12141 12151 12201 12301 12321 12341 27235 27244 27301 27370 27513 27514 36582 36583 36584 36585 36589 36590 50546 50547 50548 12501 12601 12701 12721 12741 13201 27530 27648 28118 28119 28124 28193 36595 36596 36870 37182 37183 37184 50557 50561 50562 13401 13601 13801 13821 13901 13921 28272 28285 28292 28296 28298 29065 37186 37187 37188 37200 37201 37202 50575 50576 50580 14001 14021 14041 14201 14301 14321 29075 29800 29804 29805 29806 29807 37203 37204 37205 37210 37215 37500 50684 50688 50945 14401 14421 14441 14621 14641 14701 29819 29820 29821 29822 29823 29824 38120 38570 38571 38572 39400 42550 50953 50955 50957 14721 14741 14801 14821 14841 14861 29825 29826 29827 29828 29830 29834 43200 43201 43202 43204 43205 43215 50974 50976 50980 14901 15001 15021 15201 15221 16101 29835 29836 29837 29838 29840 29843 43216 43217 43219 43220 43226 43227 51605 51610 51705 16201 16221 16301 16341 16361 16381 29844 29845 29846 29847 29848 29850 43228 43231 43232 43234 43235 43236 52000 52001 52005 16501 16521 16541 16561 16701 16801 29851 29855 29856 29860 29861 29862 43237 43238 43239 43240 43241 43242 52214 52224 52234 16821 17101 17121 17141 17161 0171T 29863 29866 29867 29868 29870 29871 43243 43244 43245 43246 43247 43248 52260 52265 52270 17301 17321 17401 17421 17441 17561 29873 29874 29875 29876 29877 29879 43249 43250 43251 43255 43256 43257 52281 52282 52283 17581 17601 17701 17721 17801 17821 29880 29881 29882 29883 29884 29885 43258 43259 43260 43261 43262 43263 52301 52305 52310 18101 18201 18291 18301 18321 18401 29886 29887 29888 29889 29891 29892 43264 43265 43267 43268 43269 43271 52320 52325 52327 18421 18441 18501 18521 18601 19161 29893 29894 29895 29897 29898 29899 43272 43279 43280 43644 43645 43647 52341 52342 52343 43653 43752 43760 52351 52352 52353 52354 52355 52400 70371 70373 70390 70460 70470 70481 78003 78006 78007 78010 78011 78015 43772 43773 43774 52402 52450 52500 52601 52630 52640 70482 70487 70488 70491 70492 70496 78016 78018 78070 78075 78102 78103 44188 44202 44204 52647 52648 52649 52700 54230 54690 70498 70542 70543 70545 70546 70547 78104 78110 78111 78120 78121 78122 44208 44210 44211 54692 55550 55866 56820 56821 57420 70548 70549 70552 70553 70558 70559 78130 78135 78140 78185 78190 78191 44361 44363 44364 57421 57423 57425 57452 57454 57455 71023 71034 71040 71060 71090 71260 78195 78201 78202 78205 78206 78215 44370 44372 44373 57456 57460 57461 58541 58542 58543 71270 71275 71551 71552 71555 72126 78216 78220 78223 78230 78231 78232 44379 44380 44382 58544 58545 58546 58548 58550 58552 72127 72129 72130 72132 72133 72142 78258 78261 78262 78264 78270 78271 Fluoroscopy 76001, Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician May Be Billed With Other Procedures Status N Not Paid Separately By Medicare Inherent in all RS&I codes May be reported for >53 minutes of dedicated staff and equipment availability Reported when fluoroscopy is the only imaging performed and no radiographs produced
76001, Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician Over 53 Minutes = One Hour (Rule 882) Dedicated Technologist and Equipment NOT Fluoroscopy Time 76001, Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician All CPT codes are not restricted to a specific specialty group. Any CPT code may be used to designate the procedures or services rendered by a qualified physician or other qualified healthcare professional 2010 cpt Professional Edition, Introduction Central Venous Access - Fluoroscopy 77001, Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure) Statistical Charge : Post CVC Placement CXR
Localization and Needle Placement 77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) Only Non-Spinal Needle Placement Performed Do Not Report With an RS&I Code More Likely to Occur in Pre-OP or Recovery Pain Injections 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint), including neurolytic agent destruction Predominately Pain Management Do not report with RS&I Do not report with Facet Injections (64490-64495) Pacemakers 71090 Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation Reported for both pacemakers and defibrillators Report post-implant Chest radiograph separately
Surgery Reports Surgical Components Radiology Reports RS&I or Statistic A/V Dialysis Description of Procedure: Local anesthesia was applied in the graft apex and a small skin incision was made. Graft was accessed medially towards the venous anastomosis. Fistulagram was performed showing Original Charge Reported: 76000 < One Hour Fluoroscopy Arterial Anastomosis DIALYSIS IN FLOW GRAFT Brachial Artery OUT FLOW Basilic or Cephalic Vein Venous Anastomosis A/V Dialysis Original Charges Corrected Charges 76000 Fluoro <1 Hour $0 N/A Statistical Charge $0 36147 AV Fistulagram $157 36147 AV Fistulagram $157 $157 $157 APC Reimbursement: Units of Service: $0 +1 Statistic Charge needed for AV Fistulagram as Only Procedure
A/V Dialysis Description of Procedure: Local anesthesia was applied in the graft apex and a small skin incision was made. Graft was accessed medially towards the venous anastomosis. Fistulagram was performed showing clot and stenosis of radial artery beyond the anastomosis. was angioplastied with a 7 mm x 4 cm balloon, and there was immediate recoil with a persistent 80% stenosis. This was then stented with a 10 mm x 25 mm Express stent with no residual stenosis. Original Charge Reported: 76001 Fluoro One Hour A/V Dialysis Original Charges Corrected Charges 76000 Fluoro <1 Hour $0 75978 RS&I Angioplasty Venous $0 36147 A/V Fistulagram $157 36147 A/V Fistulagram $157 35476-59 Angioplasty - Venous $1,656 35476-59Angioplasty - Venous $1,656 37205 Vascular Stent Plcmnt $6,357 37205 Vascular Stent Plcmnt $6,357 75960 RS&I Vasc Stent Plcmnt $0 $6,357 $6,357 APC Reimbursement: Units of Service: $0 +2 Surgery Reports Surgical Components Description of Procedure: Spine Fluoroscopy Following preparation and draping of the skin and under fluoroscopic control, 20 gauge needles were inserted into the disc spaces at the L2-3, L3-4 and L4-5 levels. Contrast was injected and the level of pain was determined. Original Charge Reported: 76001 Fluoro One Hour
Spine Fluoroscopy Original Charges 76000 Fluoro <1 Hour $0 72285 RS&I Discogram $1,690 62291 Inject Discogram $0 72285 RS&I Discogram $845 62291 Inject Discogram $0 72285 RS&I Discogram $423 62291 Inject Discogram $0 62291 Inject Discogram $0 62291 Inject Discogram $0 62291 Inject Discogram $0 $0 $2,958 APC Reimbursement: Units of Service: Corrected Charges $2,958 +3 Discograms are coded per each vertebral disc injected Description of Procedure: Laminectomy Following successful induction of general anesthesia, The left cervical region was prepped and draped in a sterile fashion. Fluoroscopy was used to identify the appropriate level. The spinous processes of C-3 and C-4 were resected. Original Charge Reported: 76000 Fluoro Less Than One Hour Laminectomy Original Charges Corrected Charges 76000 Fluoro <1 Hour $0 72020 Single View Spine $44 $0 $44 APC Reimbursement: $44 Units of Service: + 1.0 Fluoroscopy is included in all spinal surgeries.
Pacemaker DESCRIPTION OF PROCEDURE: The patient brought to the operating room The ventricular lead was passed first. The battery pack then as mentioned was a St. Jude model #PM2210, was implanted in the pocket and the pocket was closed in three separate layers. Original Charge Reported: 76000 Fluoro <1 Hour and 71090 Pacer Fluoroscopy Pacemaker Original Charges Corrected Charges 76000 Fluoro <1 Hour $0 n/a 71010 Chest Single View $44 72020 Single View Spine $44 71090 Pacemaker Fluoro $0 71090 Pacemaker Fluoro $0 $0 $0 APC Reimbursement: $0 Units of Service: OR -1 Rad +1 Check the Surgery Department s Standard Charges or Preference Card Central Venous Access DESCRIPTION OF PROCEDURE: Venous aspirate was without resistance and the wire was passed without resistance. The fluoroscopy was used to confirm adequate positioning of the wire into the vena cava. The catheter was cut to the appropriate length and secured to the port. The port was aspirated and flushed with no resistance to flow. The final position was confirmed with fluoroscopy. Original Charge Reported: 77001 CVC Fluoro and 71010 Chest Single View
Central Venous Access Original Charges Corrected Charges 76000 Fluoro <1 Hour $0 77001 Insert Venous Catheter $0 71010 Chest Single View $44 none Chest Post CVC Fluoro statistic $44 $0 APC Reimbursement Change: ($44) Units of Service: OR -1 Rad +1 CVC Fluoroscopy includes post radiograph - Statistical Charge Suggested Breast Specimen PROCEDURE IN DETAIL: incision we then were able to identify the wire and the wire was then brought out through the incision. Now with a wire being used as a guide, we were then able to perform an excision encompassing the area of concern. Specimen radiograph showed only partial area of concern and did not include all of the micro-calcifications This specimen mammogram did confirm that we had the entire area of concern Original Charge Reported: 76098 Specimen Radiograph Breast Specimen Original Charges Corrected Charges 76098 Specimen Radiograph $366 76098 Specimen Radiograph $366 76098 Specimen Radiograph $183 $366 $549 APC Reimbursement Change: $183 Units of Service: + 1 Specimen Charge is per Radiograph Also Reported for Non-Breast Specimens
Cholangiogram PROCEDURE IN DETAIL: The cystic duct was dissected free. A clip was placed on the gallbladder side of the duct. The duct was opened. A cholangiocatheter was inserted. Half and full strength cholangiogram was performed. There was an obvious filling defect Cholangiocatheter was injected There were no obvious defects. Original Charges Reported: 76001 Fluoro <1 Hour and 74300 OR Cholangiogram Cholangiogram Original Charges Corrected Charges 76001 Fluoro Over One Hour $0 74300 OR Cholangiogram $0 74300 OR Cholangiogram $0 74301 Add'l Cholangiogram $0 $0 $0 APC Reimbursement Change: $0 Units of Service: + 1 Intraoperative Cholangiogram are Reported Per Set (Injection) ERCP PROCEDURE IN DETAIL: The endoscope was inserted cannulated the cystic duct We then turned our attention to the pancreatic duct cannulated the pancreatic duct Original Charges Reported: 76001 Fluoro <1 Hour and 74300 OR Cholangiogram
ERCP Original Charges Corrected Charges 76001 Fluoro Over One Hour $0 74330 ERCP Bile & Pancreatic $0 $0 $0 APC Reimbursement Change: $0 Units of Service: + 1 ERCP has three RS&I Codes Available, Determined by Cannulation(s) Biliary Duct Guide Catheter 74328 Cannula Pancreatic Duct 74239 Both Bile & Pancreatic 74330 John s s Guidance When someone asks what you did in surgery your answer is what you should charge. AVOID REPORTING C-ARM C FLUOROSCOPY. Report the specific, appropriate CPT code.
Suggestions and Guidance Educate Your Staff Resolve Turf Issues Surgical Components to OR RS&I Components to Radiology Professional Fees???? Determine Productivity Statistics OR Minute Style Billable UOS Hybrid Combination Establish Statistical Charges Suggested Statistical Charges CDM # Department Description REV CPT Price 387XXXX RADIOLOGY POST CVC FLUORO CHEST 999 (none) $0.00 387XXXX RADIOLOGY PORTABLE CHEST 324 71010 $231.00 Chest Post Central Venous Catheter Fluoroscopy A/V Fistulagram In Surgery Facet Injection in OR OR Fluoroscopy NCCI (No RS&I to report) Fluoroscopy in Surgery 1 Hour (No RS&I to report) Fluoroscopy In Surgery 2 Hours (No RS&I to report) Fluoroscopy In Surgery 3 Hours (No RS&I to report) C-ARM CHARGE CROSSWALK Note: Charge for radiographs or c-arm images according to the number of views ARTERIOGRAQPHY Use ALL Appropriate RS&I VARIES Report RS&I Codes By Vessel(s) Imaged BILE DUCT Biliary Duct Guide Catheter 74328 Pancreatic Duct Guide 74329 Bile & Pancreatic Guide 74330 Bile Duct Dilation 74363 Only Report One per OR Session BREAST OR TISSUE SPECIMEN Specimen Radiograph (each) 76098 Report for Each Radiograph BRONCHOSCOPY Imaging Is Included STATISTIC Included In Bronoscopy - Use Statistical 'Charge' Percutaneous BX 77002 Once Per Lesion
C-ARM CHARGE CROSSWALK Note: Charge for radiographs or c-arm images according to the number of views ARTERIOGRAQPHY Use ALL Appropriate RS&I VARIES Report RS&I Codes By Vessel(s) Imaged BILE DUCT Biliary Duct Guide Catheter 74328 Pancreatic Duct Guide 74329 Bile & Pancreatic Guide 74330 Bile Duct Dilation 74363 Only Report One per OR Session BREAST OR TISSUE SPECIMEN Specimen Radiograph (each) 76098 Report for Each Radiograph BRONCHOSCOPY Imaging Is Included STATISTIC Included In Bronoscopy - Use Statistical 'Charge' 77002 Once Per Lesion Percutaneous BX ERCP Biliary Duct Guide Catheter 74328 Cannula Pancreatic Duct 74239 Both Bile & Pancreatic 74330 Only Report One of These Per OR Session FLUOROSCOPY Less Than 60 Minurtes STATISTIC Included In All OR Procedures- Use Statistical 'Charge' More than 60 Minutes 76001 Do Not Report With Radiographs Pacemaker 71090 Includes Fluoroscopy and Radiographs In OR Suite Central Venous Access 71001 Includes Fluoroscopy and Post Radiograph GI TRACT Guide Intubation 74340 Includes Fluoroscopy and Radiographs In OR Suite Dilation Esophagus 74360 Includes Fluoroscopy and Radiographs In OR Suite HIP Intraoperative 73530 Includes Fluoroscopy and Radiographs In OR Suite In Recovery (1 or 2 Views) 73560 Pelvis or AP & Lat INTERVENTIONAL VASCULAR IMAGING - Use CPTs VARIES All Imaging Codes By Anatomy Visualized Angioplasty - Extremity 75962 Once Per Vessel Angioplasty - Add'l Extremity 75964 Once Per Each Additional Vessel Angioplasty - A/V Dialysis 75978 Once Per Vessel Angioplasty - Renal First 75966 Once Per Vessel Angioplasty-Renal Each Add'l 75978 Once Per Vessel Angioplasty -Venous 75978 Once Per Vessel Stent Placement - First 75960 Once Per Vessel Stent Placement Each Add'l 75960-59 Once Per Vessel Embolization 75894 Once Per Surgical Field Thrombolysis 75896 Once Per Surgical Field Thrombo Catheter Exchange 75900 Once Per OR Session Venography - Extremity (unilat) 75820 Once Per Extremity Venacavagram Inferior 75825 Not Reported With Cava Filter Plcmnt Venacavagram Superior 75827 Not Reported With Cava Filter Plcmnt
INTRODUCTION/GUIDANCE GI Tube (Miller Abbot Type) 74340 Includes Fluoroscopy and Radiographs In OR Suite Needle Biopsy 77002 Includes Fluoroscopy and Radiographs In OR Suite Percutaneous Drainage Tube 75989 Includes Fluoroscopy and Radiographs In OR Suite Spine Injections (Ndl Plcmnt) 77003 Includes Fluoroscopy and Radiographs In OR Suite IVC FILTER PLACEMENT Cava Filter Placement 75940 Do Not Report Cavagram SPINE Guide Catheter/Needle 77003 Disc or Vertebral Biopsey and Spinal Injections Discogram Cer/Thor (each) 72285 Report Per Disc Injected Discogram Lumbar (each) 72295 Report Per Disc Injected Kyphoplasty Thoracic (each) 72291 Report Per Vertebral Body Kyphoplasty Lumbar (each) 72291 Report Per Vertebral Body Vertebroplasty (each) 72291 Report Per Vertebral Body Biopsy Vertebra 77003 Report Per Vertebral Body Localization (or Single View) 72020 Spine Level Determination (permanent image) URINARY Cystourethroscopy, Diagnostic 74485 Fluoro Only - No Films Lithoptripsey STATISTIC Included In OR Procedures- Use Statistical 'Charge' Lithoptripsey - US Ablation Renal 76940 US Ablation has an RS&I code Dilatation, Ureter or Urethera 74485 Diagnostic RPG requires modifier (-59) Retrograde Urography 74420 + Unilateral - Report Second Side With RT/LT (-50 or -59) VENOGRAPHY Use ALL Appropriate RS&I VARIES Report RS&I Codes By Vessel(s) Imaged SINGLE VIEWS Spine, Single View 72020 Per Imaging Order Joint, Single View 77077 Per Imaging Order SPONGE COUNT Abdomen 74000 Once Per Exam Pelvis 72170 Once Per Exam Chest 71010 Once Per Exam STRESS JOINT Fluoro Joint Under Stress 77071 Includes Unaffected Side
Arteriovenous Dialysis Interventions Thank you for allowing me to spend some time with you today. I hope you were entertained, learned something or at least had a nice nap. John Marshall CRA, FAHRA, RCC, RT(R) john-marshall@smh.com (941) 917-6406