Basics of Fluoroscopy CPT code 77002, 76001, 77001, 77003
Fluoroscopy is used mostly as a guidance in coding interventional radiology reports. I always used to have little confusion while using fluoroscopy CPT codes along with surgery codes. Initially it is very difficult for a coder to read and code a medical report, but once you follow the ICD and CPT coding guidelines, you become perfect in coding a medical report. Fluoroscopy CPT codes differ from procedure to procedure. For example, CPT code 77001 is used for vascular procedure while CPT code 77002 is used for non-vascular procedure like biopsy, injection etc. both are fluoroscopy codes. Also, CPT code 77003, one more fluroscopy code is used extensively only for spinal procedures.
Hence, if you are perfect in coding surgery report, you will know exactly which fluoroscopy CPT code should be used. I know, medical coders struggle a lot in coding surgery report, especially interventional radiology reports. For Clearing a Certification exam like CPC, coders must learn everything about theses codes. So, let us checkout the different fluoroscopy CPT codes 77001,77002,77003 & 76000, used along with surgery CPT codes.
CPT code 76001 is deleted in 2019.However, the intent of the code was to identify when a radiologist utilized fluoroscopy during a procedure. It was determined that, from a clinical perspective, there was no longer a need for a separate code, as more physicians are trained to perform fluoroscopy and able to directly perform the service themselves. Therefore, 76001 was deleted.
It is no longer appropriate to use CPT 76937 or 77001 for ultrasound or fluoroscopic imaging guidance in addition to 36568-36584 for peripherally inserted central venous catheters (PICC) coding. Similarly, these codes include any imaging to document the final catheter positioning, so the billing of a separate chest x-ray (71045, 71046, 71047, or 71048) will not be allowed on the same date as the PICC insertion or replacement. When the final positioning is not confirmed, the PICC procedure should have modifier -52 added to indicate the limited scope of the procedure.
Details of Fluoroscopy procedure code 77002, 76001, 77001, 77003
Fluoroscopy is a continuous x-ray beam that creates a sequence of images that are then transmitted to a monitor, which helps the provider to evaluate the structure(s) in question. Fluoroscopy may be performed to evaluate specific areas of the body, including the bones, muscles, and joints, as well as solid organs, such as the heart, lung, or kidneys. It is a radiologic imaging modality which can be performed independently or in combination with the diagnostic procedures. As we have different fluoroscopic guidance codes like 76000, 76001,77001, 77002 and 77003, we usually get confuse which one to use while coding medical reports.
Fluoroscopic guidance requires:
- Use of fluoroscopy
- Contrast injections through the access site
- Images (saved) to confirm the final catheter position
It is important to become familiar with the use of the fluoroscopy codes 77001-77003. Fluoroscopic guidance can be performed as the sole imaging associated with a procedure (77001-77003) for which both the procedure and the fluoroscopic guidance are reported. Fluoroscopy may be performed in combination with other imaging during a procedure (eg, peripherally inserted central venous catheter using both ultrasound 76937 and fluoroscopic guidance 77001) for which the procedure and both imaging codes are reported. For certain procedures, fluoroscopy is considered inclusive of the procedure (eg, 22526, 22527, 62263, 62264, 62267, 62270-62282, 62310-62319) and not separately reportable. Fluoroscopic guidance is considered inclusive of certain organ or anatomic-specific radiological supervision and interpretation procedures 74320, 74355, 74445, 74470, 74475, 75809, 75810, 75885, 75887, 75980, 75982, 75989. Since fluoroscopic imaging requires personal supervision, if the physician is not present in the operating room during a procedure that uses fluoroscopy or fluoroscopic guidance, that physician should not submit a code for fluoroscopy. However, the appropriate radiographic code to report the anatomy evaluated should be submitted in the event that (a) the radiologist’s contract with the hospital requires that a radiologist issue a formal interpretation, or (b) the physician performing the study requests that a radiologist produce a formal report of the procedure from permanent images recorded.
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Use of CPT code 77002, 77001 and 77003
These CPT codes should always be used along with their primary Surgery codes. It is very easy to differentiate between CPT 77001, 77002 and 77003. If you are vascular surgery coder, you will only use CPT code 77001. This fluoroscopy guidance code is only made for vascular coding. If you remember we have different ultrasound guidance CPT code 76937 for vascular procedure, the same way we have to use CPT code 77001, as fluoroscopic guidance code along with vascular surgery reports. If you have coded central venous catheter placement or PICC (Peripherally Inserted Central venous Catheter), you would have come across both 76937 and 77001 CPT code, for ultrasound and fluoroscopic guidance respectively.
CPT code 77002 is only used with non-vascular procedure like biopsy, injection etc. While CPT code 77003 is used for only for spinal procedures.
77002 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.
When to use Fluoroscopy CPT code 76000 and 76001
Being myself a medical coder, I always have a doubt when to use CPT codes 76000 and 76001. But, later while coding some charts related to CPT codes 76000 and 76001, I concluded few important tips. CPT code 76000 is most of the times included in the radiology procedures codes. So, coders should check the CCI edit whether CPT code 76000 is inclusive or not with the primary radiology procedure. If the fluoroscopy procedure is performed separately or independently, we have to append 59 or X{EPSU} modifier to indicate that it is a distinct or independent service. Below is the code description of the CPT code 76000.
Code 76000, Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time
You can see that the code description states that, the code should be assigned only when fluoroscopy is performed separately or independently.
CPT gives the following guidance for code 76000: “Fluoroscopy (76000) is considered to be an inclusive component of any other formal radiologic procedure and should not be reported separately. On the basis of payer requirements, modifier 59, Distinct Procedural Service, may be appended to code 76000 to indicate that a distinct or independent service was performed.”
Do remember, many endoscopic procedures like laparoscopy, arthroscopy, esophagoscopy, colonoscopy etc. codes description does not states fluoroscopy specifically. But, these procedures when use fluoroscopy, it becomes an inclusive or inherent part of the endoscopic procedure. Hence, do not assign CPT code 76000 along with these endoscopic procedures until performed separately.
Fluoroscopy is also considered inclusive or inherent to many radiological supervision and interpretation (RS&I) services, such as those provided in support of gastrointestinal examinations, arthrography, myelography, cholecystography, venography, arteriography, and cystography. Hence, it is not appropriate to Code CPT 76000 or 76001 along with RS&I codes. Also, other fluoroscopy CPT codes 77001, 77002 and 77003 have also been included in few new CPT codes.
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Coding tips for Fluoroscopy CPT code 76000 and 76001 (deleted in 2019)
As we know, we can use CPT code 76000 only when we it performed separately. For example, a patient comes with an injury to the physician in radiology department, and the physician only uses fluoroscopy to examine the bones being fractured or dislocated. In such scenario, when the fluroscopy is the only exam performed by the physician we can bill the CPT code 76000 as separate and independent procedure.
Also, we can use fluoroscopy code 76000, when we do not have any other code for the exam performed. For example, if fluoroscopy is used to locate a foreign body in the skin and used to remove it from the skin, without taking any hard copy images, here CPT code 77001, 77002 and 77003 will not accurately describe this procedure. Hence, use CPT code 76000 is such scenario to indicate it is separate procedure and use 59 or X-modifier to designate it as a distinct procedure.
Below are the few RS&I CPT codes which includes CPT code 76000 and hence should not be reported separately along with these codes.
75885 Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation
75887 Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation
75989 Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation
CPT code 76001, is considered as a stand alone code when fluoroscopy is the only imaging performed.
Code 76001, Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician
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Hope, now all the surgery medical coders have gain some knowledge in coding fluoroscopy CPT codes 77002, 77001 and 77003. Do share you thoughts in the comment section.