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i d f or a P t e G How to rvices e S g n Imagi urgery S n i d me Perfor John Marshall CRA, RCC, RT(R), FAHRA [email protected] 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’ Today’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! aid for P t e G How to es g Servic Imagin Surgery n i d e m Perfor John Marshall CRA, RCC, RT(R), FAHRA [email protected] 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 Coding Term Bundling Applied to Sub-Components Not Reported Separately Financial Term Packaging 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 es Turf Battl 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 CO P Y S O R O U FL 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 1261 1481 1741 2121 2221 3521 4501 5001 5301 5411 0055T 5671 6251 6401 7501 0078T 8001 8321 8461 8651 8801 9101 9211 9321 9441 11301 11801 12141 12501 13401 14001 14401 14721 14901 16201 16501 16821 17301 17581 18101 18421 43653 43772 44188 44208 44361 44370 44379 1021 1401 1601 1761 2141 3001 4001 4521 5201 5321 5421 5601 5801 6261 6701 7521 7901 8021 8341 8481 8661 8821 9121 9221 9341 9481 11401 11901 12151 12601 13601 14021 14421 14741 15001 16221 16521 17101 17321 17601 18201 18441 43752 43773 44202 44210 44363 44372 44380 1031 1421 1621 1901 2151 3201 4021 4541 5221 5341 5461 5611 6001 6301 7001 7541 7921 0080T 8361 8511 8681 9021 9141 9241 9361 9501 11501 12001 12201 12701 13801 14041 14441 14801 15021 16301 16541 17121 17401 17701 18291 18501 43760 43774 44204 44211 44364 44373 44382 1041 1441 1641 1921 2161 3221 4041 4701 5241 5371 5481 5621 6041 6321 7021 7561 7941 8101 8401 8601 8701 9041 9161 9261 9381 9521 11601 12021 12301 12721 13821 14201 14621 14821 15201 16341 16561 17141 17421 17721 18301 18521 52351 52402 52647 54692 57421 57456 58544 1201 1451 1701 2101 2181 3261 4061 4721 5281 5391 0054T1 5631 6201 6341 7301 0075T1 7961 8201 8421 8621 8721 9061 9181 9281 9401 11121 11701 12101 12321 12741 13901 14301 14641 14841 15221 16361 16701 17161 17441 17801 18321 18601 52352 52450 52648 55550 57423 57460 58545 1241 1471 1721 2111 2201 3501 4101 4741 5291 5401 5501 5661 6221 6351 7401 7701 7971 8301 8441 8641 8731 9081 9201 9301 9421 11201 11731 12121 12341 13201 13921 14321 14701 14861 16101 16381 16801 0171T 17561 17821 18401 19161 52353 52500 52649 55866 57425 57461 58546 19201 19311 19521 19631 19901 19030 20500 20553 20680 20957 22100 22206 22222 22319 22521 22554 22610 22808 22842 22856 23350 24685 25606 25671 26432 26554 26725 27036 27235 27530 28272 29075 29819 29825 29835 29844 29851 29863 29873 29880 29886 29893 52354 52601 52700 56820 57452 58541 58548 19221 19321 19581 19651 19911 19296 20501 20600 20694 20982 22101 22207 22224 22325 22523 22556 22612 22810 22849 22857 24149 25246 25607 25800 26525 26555 26727 27093 27244 27648 28285 29800 29820 29826 29836 29845 29855 29866 29874 29881 29887 29894 52355 52630 54230 56821 57454 58542 58550 19241 19331 0195T1 19661 19921 19297 20526 20605 20696 20985 22102 22210 22305 22326 22524 22558 22630 22812 22850 22861 24220 25447 25608 26010 26541 26556 26735 27095 27301 28118 28292 29804 29821 29827 29837 29846 29856 29867 29875 29882 29888 29895 52400 52640 54690 57420 57455 58543 58552 19251 19351 19601 19671 10021 19298 20550 20610 20697 21116 22110 22212 22310 22327 22532 22590 22800 22818 22851 22862 24435 25565 25609 26185 26546 26608 26742 27096 27370 28119 28296 29805 29822 29828 29838 29847 29860 29868 29876 29883 29889 29897 70371 70482 70498 70548 71023 71270 72127 19261 19361 19611 19681 11042 20206 20551 20612 20902 22010 22112 22214 22315 22505 22533 22595 22802 22819 22852 22864 24500 25600 25651 26356 26551 26615 26746 27130 27513 28124 28298 29806 29823 29830 29840 29848 29861 29870 29877 29884 29891 29898 70373 70487 70542 70549 71034 71275 72129 19301 19511 19621 19691 11043 20220 20552 20670 20956 22015 22114 22220 22318 22520 22548 22600 22804 22830 22855 22865 24516 25605 25652 26426 26553 26665 26860 27138 27514 28193 29065 29807 29824 29834 29843 29850 29862 29871 29879 29885 29892 29899 70390 70488 70543 70552 71040 71551 72130 29900 29907 31239 31276 31293 31513 31528 31540 31570 31579 31626 31636 31646 32603 32652 32658 32664 33206 33215 33225 33249 33883 34804 34830 36002 36555 36563 36571 36582 36595 37186 37203 38120 43200 43216 43228 43237 43243 43249 43258 43264 43272 70460 70491 70545 70553 71060 71552 72132 29901 31231 31240 31287 31294 31515 31529 31541 31571 31615 31628 31638 31656 32604 32653 32659 32665 33207 33216 33226 33265 33886 34805 34831 36005 36556 36565 36575 36583 36596 37187 37204 38570 43201 43217 43231 43238 43244 43250 43259 43265 43279 70470 70492 70546 70558 71090 71555 72133 29902 31233 31254 31288 31505 31520 31530 31545 31575 31622 31629 31640 31715 32605 32654 32660 32997 33208 33217 33234 33266 33967 34806 34832 36147 36557 36566 36576 36584 36870 37188 37205 38571 43202 43219 43232 43239 43245 43251 43260 43267 43280 70481 70496 70547 70559 71260 72126 72142 29904 31235 31255 31290 31510 31525 31531 31546 31576 31623 31630 31641 32550 32606 32655 32661 32998 33210 33218 33235 33508 34800 34808 34833 36475 36558 36568 36578 36585 37182 37200 37210 38572 43204 43220 43234 43240 43246 43255 43261 43268 43644 78003 78016 78104 78130 78195 78216 78258 29905 31237 31256 31291 31511 31526 31535 31560 31577 31624 31631 31643 32601 32650 32656 32662 33202 33211 33220 33243 33880 34802 34820 34834 36478 36560 36569 36580 36589 37183 37201 37215 39400 43205 43226 43235 43241 43247 43256 43262 43269 43645 78006 78018 78110 78135 78201 78220 78261 29906 31238 31267 31292 31512 31527 31536 31561 31578 31625 31635 31645 32602 32651 32657 32663 33203 33214 33224 33244 33881 34803 34825 34900 36481 36561 36570 36581 36590 37184 37202 37500 42550 43215 43227 43236 43242 43248 43257 43263 43271 43647 78007 78070 78111 78140 78202 78223 78262 43648 43761 44180 44205 44212 44365 44376 44383 44391 45300 45315 45331 45338 45355 45383 45392 46604 46614 47382 47554 47563 49320 49400 49441 49460 49655 50386 50398 50546 50557 50575 50684 50953 50974 51605 52000 52214 52260 52281 52301 52320 52341 78010 78075 78120 78185 78205 78230 78264 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 43651 43770 44186 44206 44227 44366 44377 44385 44392 45303 45317 45332 45339 45378 45384 45395 46606 46615 47500 47555 47564 49321 49411 49442 49650 49656 50387 50541 50547 50561 50576 50688 50955 50976 51610 52001 52224 52265 52282 52305 52325 52342 78011 78102 78121 78190 78206 78231 78270 43652 43771 44187 44207 44360 44369 44378 44386 44393 45305 45320 45333 45340 45379 45385 45397 46608 47370 47505 47556 47570 49322 49423 49446 49651 49657 50389 50542 50548 50562 50580 50945 50957 50980 51705 52005 52234 52270 52283 52310 52327 52343 78015 78103 78122 78191 78215 78232 78271 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 IN FLOW DIA LYS IS GR AF T Brachial Artery OUT FLOW Basilic or Cephalic Vein Venous Anastomosis A/V Dialysis Original Charges 76000 36147 Fluoro <1 Hour AV Fistulagram Corrected Charges $0 $157 $157 APC Reimbursement: Units of Service: N/A Statistical Charge 36147 AV Fistulagram $0 +1 Statistic Charge needed for AV Fistulagram as Only Procedure $0 $157 $157 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 76000 36147 35476-59 37205 Fluoro <1 Hour A/V Fistulagram Angioplasty - Venous Vascular Stent Plcmnt Corrected Charges $0 $157 $1,656 $6,357 75978 RS&I Angioplasty Venous 36147 A/V Fistulagram 35476-59Angioplasty - Venous 37205 Vascular Stent Plcmnt 75960 RS&I Vasc Stent Plcmnt $6,357 APC Reimbursement: Units of Service: $0 $157 $1,656 $6,357 $0 $6,357 $0 +2 Surgery Reports Surgical Components Spine Fluoroscopy Description of Procedure: 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 62291 62291 62291 Fluoro <1 Hour Inject Discogram Inject Discogram Inject Discogram Corrected Charges $0 $0 $0 $0 72285 72285 72285 62291 62291 62291 RS&I Discogram RS&I Discogram RS&I Discogram Inject Discogram Inject Discogram Inject Discogram $0 APC Reimbursement: Units of Service: $1,690 $845 $423 $0 $0 $0 $2,958 $2,958 +3 Discograms are coded per each vertebral disc injected Laminectomy Description of Procedure: 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 $0 APC Reimbursement: Units of Service: $44 + 1.0 Fluoroscopy is included in all spinal surgeries. $44 $44 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 71010 Chest Single View 71090 Pacemaker Fluoro $0 $44 $0 n/a 72020 Single View Spine 71090 Pacemaker Fluoro $0 APC Reimbursement: Units of Service: $44 $0 $0 $0 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 76000 Fluoro <1 Hour 71010 Chest Single View Corrected Charges $0 $44 $44 77001 Insert Venous Catheter none Chest Post CVC Fluoro APC Reimbursement Change: Units of Service: $0 statistic $0 ($44) 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 76098 Specimen Radiograph Corrected Charges $366 76098 Specimen Radiograph 76098 Specimen Radiograph $366 APC Reimbursement Change: Units of Service: Specimen Charge is per Radiograph Also Reported for Non-Breast Specimens $183 +1 $366 $183 $549 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 76001 Fluoro Over One Hour 74300 OR Cholangiogram Corrected Charges $0 $0 $0 74300 OR Cholangiogram 74301 Add'l Cholangiogram APC Reimbursement Change: Units of Service: $0 +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 $0 $0 $0 ERCP Original Charges 76001 Fluoro Over One Hour Corrected Charges $0 $0 74330 ERCP Bile & Pancreatic APC Reimbursement Change: Units of Service: $0 +1 ERCP has three RS&I Codes Available, Determined by Cannulation(s) Biliary Duct Guide Catheter Cannula Pancreatic Duct Both Bile & Pancreatic 74328 74239 74330 John’ John’s Guidance When someone asks what you did in surgery …your answer is what you should charge. AVOID REPORTING CC-ARM FLUOROSCOPY. Report the specific, appropriate CPT code. $0 $0 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’ Charges’ CDM # 387XXXX 387XXXX Department Description REV RADIOLOGY POST CVC FLUORO CHEST RADIOLOGY PORTABLE CHEST 999 324 CPT Price (none) $0.00 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 Pancreatic Duct Guide Bile & Pancreatic Guide Bile Duct Dilation 74328 74329 74330 74363 Only Report One per OR Session BREAST OR TISSUE SPECIMEN Specimen Radiograph (each) 76098 Report for Each Radiograph BRONCHOSCOPY Imaging Is Included Percutaneous BX STATISTIC Included In Bronoscopy - Use Statistical 'Charge' 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 Pancreatic Duct Guide Bile & Pancreatic Guide Bile Duct Dilation 74328 74329 74330 74363 Only Report One per OR Session BREAST OR TISSUE SPECIMEN Specimen Radiograph (each) 76098 Report for Each Radiograph BRONCHOSCOPY Imaging Is Included Percutaneous BX STATISTIC Included In Bronoscopy - Use Statistical 'Charge' 77002 Once Per Lesion ERCP Biliary Duct Guide Catheter Cannula Pancreatic Duct Both Bile & Pancreatic 74328 74239 74330 Only Report One of These Per OR Session FLUOROSCOPY Less Than 60 Minurtes More than 60 Minutes Pacemaker Central Venous Access STATISTIC 76001 71090 71001 Included In All OR Procedures- Use Statistical 'Charge' Do Not Report With Radiographs Includes Fluoroscopy and Radiographs In OR Suite Includes Fluoroscopy and Post Radiograph GI TRACT Guide Intubation Dilation Esophagus 74340 74360 Includes Fluoroscopy and Radiographs In OR Suite Includes Fluoroscopy and Radiographs In OR Suite 73530 73560 Includes Fluoroscopy and Radiographs In OR Suite Pelvis or AP & Lat HIP Intraoperative In Recovery (1 or 2 Views) INTERVENTIONAL VASCULAR IMAGING - Use CPTs Angioplasty - Extremity Angioplasty - Add'l Extremity Angioplasty - A/V Dialysis Angioplasty - Renal First Angioplasty-Renal Each Add'l Angioplasty -Venous Stent Placement - First Stent Placement Each Add'l Embolization Thrombolysis Thrombo Catheter Exchange Venography - Extremity (unilat) Venacavagram Inferior Venacavagram Superior VARIES 75962 75964 75978 75966 75978 75978 75960 75960-59 75894 75896 75900 75820 75825 75827 All Imaging Codes By Anatomy Visualized Once Per Vessel Once Per Each Additional Vessel Once Per Vessel Once Per Vessel Once Per Vessel Once Per Vessel Once Per Vessel Once Per Vessel Once Per Surgical Field Once Per Surgical Field Once Per OR Session Once Per Extremity Not Reported With Cava Filter Plcmnt Not Reported With Cava Filter Plcmnt INTRODUCTION/GUIDANCE GI Tube (Miller Abbot Type) Needle Biopsy Percutaneous Drainage Tube Spine Injections (Ndl Plcmnt) 74340 77002 75989 77003 Includes Fluoroscopy and Radiographs In OR Suite Includes Fluoroscopy and Radiographs In OR Suite Includes Fluoroscopy and Radiographs In OR Suite Includes Fluoroscopy and Radiographs In OR Suite 75940 Do Not Report Cavagram 77003 72285 72295 72291 72291 72291 77003 72020 Disc or Vertebral Biopsey and Spinal Injections Report Per Disc Injected Report Per Disc Injected Report Per Vertebral Body Report Per Vertebral Body Report Per Vertebral Body Report Per Vertebral Body Spine Level Determination (permanent image) IVC FILTER PLACEMENT Cava Filter Placement SPINE Guide Catheter/Needle Discogram Cer/Thor (each) Discogram Lumbar (each) Kyphoplasty Thoracic (each) Kyphoplasty Lumbar (each) Vertebroplasty (each) Biopsy Vertebra Localization (or Single View) URINARY Cystourethroscopy, Diagnostic Lithoptripsey Lithoptripsey - US Ablation Renal Dilatation, Ureter or Urethera Retrograde Urography 74485 STATISTIC 76940 74485 74420 + Fluoro Only - No Films Included In OR Procedures- Use Statistical 'Charge' US Ablation has an RS&I code Diagnostic RPG requires modifier (-59) 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 Joint, Single View SPONGE COUNT Abdomen Pelvis Chest 72020 77077 Per Imaging Order Per Imaging Order 74000 72170 71010 Once Per Exam Once Per Exam Once Per Exam 77071 Includes Unaffected Side STRESS JOINT Fluoro Joint Under Stress 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) [email protected] (941) 917-6406
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