Author Topic: fluoroscopy procedures  (Read 2659 times)

tlewis

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fluoroscopy procedures
« on: January 20, 2011, 12:46:51 PM »
Ok I work for a freestanding multi-specialty ASC. We have a Mini-Carm and have been told over and over again by the docs that we cannont get paid for the use of the fluoroscopy procedures. However 76496 Fluoroscopic procedure Z2 Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight. The C-arm is generaly used for podiatry and ortho cases and are used to insure the implants are implanted correctly. I think I should be able to bill because it is integral to the case as long as I bill with a TC modifier and the phys bills with a 26 modifier and there is a hard copy in the patients file. Any insight on this would be great!!

Thanks
Tracy  ;D

Michele

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Re: fluoroscopy procedures
« Reply #1 on: January 22, 2011, 07:19:20 PM »
If it was used, it can be billed.  I would think the question would be is it going to be allowed.  Each insurance plan will have different guidelines on whether or not they pay for it.  I haven't personally been faced with this situation.

Best of luck!

Michele
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tlewis

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Re: fluoroscopy procedures
« Reply #2 on: January 27, 2011, 02:21:04 PM »
Actually that is not a true statement for a freestanding ASC. I would run the risk of unbundling a procedure. If it is not considered to be on OPPS passthough status and I bill for it it could put me in alot of trouble with Medicare and flag an audit.  CPT 77003 while billable for a hospital in accordance with CPT 62267, 62270-6282. 62310-62319 CPT 77003 is not on the OPPS pass through status for a free standing ASC so not billable As far as I can tell.  I can for statistic purposes add a modifier GY. Most "extras" ie supplies, injections, Implants are considered to be included in the reimbursent for the procedure performed. There are a few that are on pass through status but not many.
Mostly I don't want to be billing for items that would make medicare ask, now why would this office think that they can bill for this and what else are they billling for that the "ought not to be"  ::) So I guess what my problem is, is that I can't find any hard document that says its ok for me to bill a 76496 with an ORIF. with out that evidence to have in my hot little hand it make me nervous to "ass-u-me" that it is ok.