Repoting fluoroscopy procedure codes

Other Requirements Associated with Reporting Fluoroscopy Procedure Codes

According to Medicare regulations, fluoroscopy procedures performed in physician offices,
IDTFs and, with certain exceptions, facilities designated by CMS as provider-based facilities
require personal supervision (i.e., a physician in attendance in the room during the performance
of the procedure).9 This requirement should typically be met because the fluoroscopy procedure
is performed in conjunction with a pain management procedure by a physician. Further, fluoroscopy procedures provided in hospital inpatient and outpatient settings should follow the
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation
standards and internal hospital policies. Fluoroscopy services should not be coded or billed
unless these requirements are met.

Many of the pain management codes are subject to National Correct Coding Initiative (NCCI)
edits. NCCI edits are pairs of CPT or Healthcare Common Procedure Coding System (HCPCS)
codes that are not separately coded and payable except under certain circumstances. The edits
are applied to services billed by the same provider for the same beneficiary on the same date of
service and are updated on a quarterly basis. The NCCI edits may be obtained through the CMS
website at: http://www.cms.hhs.gov/NationalCorrectCodInitEd/.

When submitting claims to Medicare, procedural CPT codes are reported with diagnosis codes
describing the patient’s documented medical condition. These diagnoses are reported using the
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).