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Update: AMA Clarifies Fluoroscopy Coding Guidance

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CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.



Nov. 2010's CPT Assistant article states that fluoroscopy is inclusive to ESI codes and that it should not be reported: "For certain procedures, fluoroscopy is considered inclusive of the procedure (e.g., 22526, 22527, 62263, 64467, 62270-62282, 62310-62319) and not separately reportable."

It was our concern that since payors utilize the American Medical Association as an authoritative reference for their edit systems, they might target these codes and deny the fluoroscopy codes based on this article. We sent an e-mail to AMA requesting clarification because AMA has traditionally reported fluoroscopy as being separately reportable and this article seemed to deviate from prior statements.

In an e-mail response back, AMA admitted that an error was made by including these codes in the CPT Assistant article and printed a correction notice that can be found at www.ama-assn.org/ama1/pub/upload/mm/362/errata-nov2010.pdf.  

Per this correction, AMA adheres to traditional CPT Assistant instruction with the following paragraph:

"The following provides correction of the inclusion/exclusion of fluoroscopic guidance: For certain spinal procedures, fluoroscopy is NOT considered inclusive of the procedure (e.g., 62267, 62270-62282, 62310-62319) and is indeed separately reportable, when performed."

It is definitely in the facility's best interest to maintain an open dialogue with the AMA if and when discrepancies are found.

 

Contact Leslie Johnson at ljohnson@medi-corp.com. Learn more about Medi-Corp.

 

The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.

 

Read more from Leslie Johnson:

 

- Coder's Guide to Epidurogram (CPT 72275)

 

- Proper Coding of Nerve Block With EMG Guidance Requires Careful Review of OP Report

 

- Understand When Modifier -59 is Appropriate for Use With 62311 (Lumbar Epidural) and Other Pain Procedures

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