Author Topic: Motion Xrays 76496?  (Read 2695 times)

dfranklin

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Motion Xrays 76496?
« on: July 08, 2010, 04:43:05 PM »
My provider does Motion XRAYs and has been using 76496.  Only Erie Insurance has paid on this and only one time.

My provider is wondering:

Is there another code we can use or a report we can use that will help get this paid? Or should they just eat the service or stop the service?

oneround

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Re: Motion Xrays 76496?
« Reply #1 on: July 08, 2010, 05:33:37 PM »
df,
I am gioing to assume that your provider is performing this service with a C-arm and during a surgical procedure.
If surgery is the case make sure that fluro is not part of the surgical procedure.  Also, this is an unlisted procedure code and most carriers require a special report identifying the procedure
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

dfranklin

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Re: Motion Xrays 76496?
« Reply #2 on: July 08, 2010, 05:51:35 PM »
It is a Chiropractor, not done during a surgery.  It is diagnostic/interventional.  So maybe it just needs the special report as I know we are not sending any type of report. I guess I can ask the provider to supply a report and then we can see if that helps get it paid.

oneround

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Re: Motion Xrays 76496?
« Reply #3 on: July 08, 2010, 06:19:21 PM »
I believe that attaching the report may help your cause.
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

dfranklin

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Re: Motion Xrays 76496?
« Reply #4 on: July 08, 2010, 06:21:22 PM »
Thanks! I will do just that!

dfranklin

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Re: Motion Xrays 76496?
« Reply #5 on: July 12, 2010, 05:34:17 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: Motion Xrays 76496?
« Reply #6 on: July 13, 2010, 06:21:47 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