Author Topic: Video Flouroscopy (Video Motion Xray) Coding  (Read 9684 times)

dfranklin

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Video Flouroscopy (Video Motion Xray) Coding
« on: June 03, 2010, 12:37:54 AM »
Does anyone know the correct coding for video Flouroscopy or Video Motion Xray?  I have seen where they say to use the 76496 code but when I did that I had an insurance (UPMC) come back and say there is a specific code to use rather than the unlisted 76496.  My provider showed me an article for someone that has testified as an expert on this topic and shows evidence that it should be coded as 76496.  What do I do?  When I use 76496 insurance says it needs a specific code and rejects it. (My provider said if 76496 is not working what about 76125?)

Any ideas?

oneround

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Re: Video Flouroscopy (Video Motion Xray) Coding
« Reply #1 on: June 03, 2010, 11:51:07 AM »
 

The component that determines the coding is the action being described ("-graphy" vs "-scopy").

 

These words are used in the CPT code and the diagnostic reports:

videoradiography (the process of recording x-ray produced motion)

videofluoroscopy (the use of an instrument for viewing luminescent motion)

 

The radiologist is not in error when he reports viewing the procedure with videofluoroscopy (viewing luminescent motion). Fluoroscopy and Videofluoroscopy can be used interchangeably, unless we are discussing antique methods of the technology. In professional articles, radiologists use the term “videofluoroscopy”. No articles in the American Journal of Radiology use the terminology: videoradiography (cineradiography stopped appearing in articles by 1990).

However, we cannot code the service as videoradiography (recording radiation motion) unless a recording is made.  

 

1. CPT code 74230 specifies "Videoradiography', so it requires a record of the procedure.

2. "Videofluoroscopy" is an acceptable terminology for the radiologist whether or not a recording has taken place.

 

DETAILS:

 In the CPT codes, there are only 3 codes that use the terminology: "cineradiography" or "videoradiography"

74230 - Swallowing function, with cineradiography/videoradiography

76120 - Cineradiography/videoradiography, except where specifically included

76125 - Cineradiography/videoradiography to complement routine examination (List separately in addition to code for primary procedure)

 

No CPT codes with terminology: videofluoroscopy, videofluorography, cinefluroscopy, cinefluorography

No results

 

Search Term: fluoroscopy, fluoroscopic

Multiple – see table below.

Note - IF videoradiography was equivalent to videofluoroscopy, why would the codes 76120, 76125 be necessary, with all the fluoro guidance codes we already have?

 

CPT
 Description
 Effective Date
 Expired Date
 Revised Date
 
All  CPT codes with words "cineradiography" or "videoradiography"
 
74230
 Swallowing function, with cineradiography/videoradiography
 01/01/1994 *
  
  
 
76120
 Cineradiography/videoradiography, except where specifically included
 01/01/1994 *
  
  
 
76125
 Cineradiography/videoradiography to complement routine examination (List separately in addition to code for primary procedure)
  
  
  
 
All 70000 CPT codes with words "fluorscopy" or "fluorscopic" (no temporary codes)
 
70370
 Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique
 01/01/1994 *
  
  
 
71023
 Radiologic examination, chest, 2 views, frontal and lateral; with fluoroscopy
 01/01/1994 *
  
  
 
71034
 Radiologic examination, chest, complete, minimum of 4 views; with fluoroscopy
 01/01/1994 *
  
  
 
71090
 Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation
 01/01/1994 *
  
  
 
72291
 Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance
 1/1/2007
  
 1/1/2010
 
75791
 Angiography, arteriovenous shunt (eg, dialysis patient fistula/graft), complete evaluation of dialysis access, including fluoroscopy, image documentation and report (includes injections of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava), radiological supervision and interpretation
 1/1/2010
  
  
 
75984
 Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), radiological supervision and interpretation
 01/01/1994 *
  
 1/1/2008
 
75989
 Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation
 01/01/1994 *
  
 1/1/2003
 
76000
 Fluoroscopy (separate procedure), up to 1 hour physician time, other than 71023 or 71034 (eg, cardiac fluoroscopy)
 01/01/1994 *
  
  
 
76001
 Fluoroscopy, physician time more than 1 hour, assisting a nonradiologic physician (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)
 01/01/1994 *
  
  
 
76496
 Unlisted fluoroscopic procedure (eg, diagnostic, interventional)
 1/1/2003
  
  
 
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)
 1/1/2007
  
  
 
77002
 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
 1/1/2007
  
  
 
77003
 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, or sacroiliac joint), including neurolytic agent destruction
 1/1/2007
  
 1/1/2010
 
 
  
  
  
  
 
92611
 Motion fluoroscopic evaluation of swallowing function by cine or video recording
 1/1/2003
  
  
 
G0272
 Naso/oro gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)
 1/1/2003
 3/31/2004
  
 
10000-69999 CPT codes with words "including fluoroscopy, image documentation and report"
 
36147
 Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava)
 1/1/2010
  
  
 
36598
 Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report
 1/1/2006
  
  
 

 

I owe Brandon and apology – there is no difference in today’s technology when it comes to fluoroscopy and videofluoroscopy. (I am happy to explain the differences if you are interested – but they apply to the educational forum; not our practical world.)

~Kelleen

 

Resources:

 

Coder’s Desk Reference:

76120-76125 (76120, 76125)

  

Cineradiography uses high speed x-ray films to take a series of images of an organ or system in motion such as the vocal cords or heart. These images taken in exposure ranges of nanoseconds to milliseconds are like the individual frames of a motion picture. This allows the movement to be frozen and tracked very minutely to gather information about time-varying characteristics. Use 76120 when performed alone and not specifically included as part of the procedure. Use 76125 when cineradiography is performed in conjunction with a routine exam.

 

 

ACR Q&A:

http://www.acr.org/Hidden/Economics/FeaturedCategories/Pubs/coding_source/archives/JanFeb08/QA.aspx

How is digital motion fluoroscopy reported? Is it appropriate to report the videoradiography code 76120?

Yes, digital motion fluoroscopy should be reported using CPT code 76120 (Cineradiography/videoradiography, except where specifically included). Because the study is recorded digitally does not negate the use of code 76120. As noted in the American Medical Association’s September 2000 CPT Assistant (p 4), both videofluorography and cineradiography are used to record motion at fluoroscopy.

Videofluorography is the recording of motion on videotape or on a digital disk from a television monitor mounted on the output port of a fluoroscopic image intensifier. Cineradiography is a motion picture recording produced by a camera attached to the output port of a fluoroscopic image intensifier. Both are methodologies for recording moving events as seen by a physician at fluoroscopy.

 

AMA CPT Assistant:

            Cineradiography vs videofluorography

      CPT Assistant, September 2000 Page: 4 Category: Coding Communications

 

Coding for Videofluorography (Videofluoroscopy) vs. Cineradiography

 

Coding for videofluorography and cineradiography services can be a challenge, especially in determining the differences between the procedures. The term videofluoroscopy is synonymous with videofluorography, with the latter being the preferred term. Videofluorography and cineradiography are similar in that they are both methods for recording motion at fluoroscopy. Cineradiography is a motion picture recording produced by a camera attached to the output port of a fluoroscopic image intensifier. Videofluorography is the recording of motion on videotape or on a digital disk from a television monitor mounted on the output port of a fluoroscopic image intensifier. Both are methodologies for recording moving events as seen by a physician at fluoroscopy. They differ in that cineradiography records motion on individual frames of a motion picture film. The frames are then played back at a rapid enough rate to cause visual integration of the individual frames, giving the perception of motion identical to that experienced in viewing a motion picture in a movie theater. Videofluorography rapidly records motion as video image frames on videotape or as individual tracts on a digital hard disk. Both cineradiography or videofluorography images can be played back at varying rates of speed from stop action to fast action for review and interpretation.

 

Although cineradiography is its own hard copy (since images are recorded on film) individual frames can be blown-up from the typical 35mm format and stored as such. Hard copies can also be obtained from individual image frames on videotape or on a hard disk by use a multiformat camera. Either type of the hard copy image may be used for permanent storage of selected frames of a motion study. There is a distinction between a fluoroscopic procedure, in which one or more spot films are taken as part of the fluoroscopic procedure, and either cineradiography or videofluorography motion recording, from which a few frames may be selected for permanent hard-copy documentation.

 

Correction/Clarification Notice:
 "In accordance with CPT Assistant, November 2000, the last sentence of the following paragraph should not have appeared in this article." ("IV injection of photoactive drug (90784) should be reported separately, if done on a different day.")

 

 

Codes 76120, Cineradiography, except where specifically included, and 76125, Cineradiography to complement routine examination (List separately in addition to code for primary procedure), are intended to identify the use of imaging to produce a "motion picture" view of the anatomic area studied, whether by motion picture film (cineradiography) or by continuous video imaging recording (videofluorography), and the subsequent interpretation and report provided. In addition, if different anatomic areas of the body are imaged and recorded (eg, cervical spine and knee), then the imaging for each anatomic area should be separately identified with a separate videofluorography/cineradiography code. Modifier -59, Distinct Procedural Service, should be appended to code 76120 or 76125 to indicate the additional anatomical region studied. Additional codes should not be used for additional views of the same anatomic area, as additional views for one area are inclusive components of the videofluorographic/cineradiographic procedure performed. IV injection of photoactive drug (90784) should be reported separately, if done on different day.

 

Since specific codes are included in CPT for this imaging procedure, the unlisted code 76499 should not be used to identify a cineradiography or videofluorography procedure.

 

 
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

dfranklin

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Re: Video Flouroscopy (Video Motion Xray) Coding
« Reply #2 on: July 12, 2010, 04:30:18 PM »
My provider is looking for strained ligaments - so they RECORD the motion of the spinal vertebra and discs etc. on DVD so that it can be played back later - THe DVD is how we store the X-ray etc for the test.

Does 74230 REQUIRE it to be for the "Swallowing" function? or would 74230 work in this case since there is a recording of the video?

Or would 76120 or 76125 be better?

Or should he stick to using the unlisted flouroscopic 76496. Seems like since he is making a recording of the video one of the others would more closely match than this one.

What do you think? (of course with any of them a report will need to be sent too). But what code?

oneround

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Re: Video Flouroscopy (Video Motion Xray) Coding
« Reply #3 on: July 13, 2010, 11:38:57 AM »
Let me knock out my meetings df and I'll review on this later this pm
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

oneround

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Re: Video Flouroscopy (Video Motion Xray) Coding
« Reply #4 on: July 13, 2010, 02:42:02 PM »

Df, I would code the 76120 or the 76125 depending upon notes and because this procedure is considered investigational for chiro purposes make sure attached the notes.  There are codes for this type of chiro procedure

Some chiropractors may bill under the code: 76499 - unlisted diagnostic radiographic procedure.  This is not appropriate, since valid codes for the procedure do exist.

Hope this helps


76120 technical component        $202.37
76120 professional component   $148.42
76125 technical component          $79.53
76125 professional component     $35.89
--------------------------------------------------------------------------------

Description:



Dynamic Motion X-ray (DMX), also known as cineradiography and videofluoroscopy of the spine has been investigated as an imaging tool to aid in diagnoses and assessment. It is promoted as a way to enable the treating physician to visualize the internal and external movements of the spinal column or biomechanics simultaneously.  Videotaping of fluoroscopic images shows normal and abnormal joint motion, fractures, ligament damage and other anomalies.  It has been investigated for use as an aid in the evaluation of musculoskeletal disorders and in a number of orthopedic, neurosurgical and chiropractic applications.







DMX, cineradiography and videofluoroscopy of the spine are considered investigational.




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Procedure Codes and Billing Guidelines: 

To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes.
CPT 76120 Cineradiography/videoradiography, except where specifically included
CPT 76125 Cineradiography/videoradiography to complement routine examination (List separately in addition to code for primary procedure)   
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Selected References:


Blue Cross Blue Shield Association. Medical Policy Reference Manual. (3:2008) Dynamic Spinal Visualization (6.01.46). Retrieved February 10, 2009.
Okawa A, Shinomiya K, Komori H, Muneta T, Arai Y, Nakai O. Dynamic motion study of the whole lumbar spine by videofluoroscopy. Spine 1998 Aug 15;23(16):1743-9.
Takayanagi K, Takahashi K, Yamagata M, Moriya H, Kitahara H, Tamaki T.Using cineradiography for continuous dynamic-motion analysis of the lumbar spine. Spine 2001 Sep 1;26(17):1858-65.
Zheng Y, Nixon MS, Allen R. Automated segmentation of lumbar vertebrae in digital videofluoroscopic images. IEEE Trans Med Imaging. 2004;23(1):45-52.
ECRI. Videofluoroscopy of the Spine or Diagnosing Instability. Plymouth Meeting (PA): ECRI Health Technology Information Service; 2008 April 16. 7p. (ECRI Hotline Response). Also available: http://www.ecri.org
 
 
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare