February 28, 2009

ACR Radiology Coding Source™ January-February 2009

Update on Fluoroscopy Coding

(Reprinted from ACR Bulletin, March 2002) 

For many years the American College of Radiology (ACR) has received questions about the appropriate coding for fluoroscopic guidance, e.g., what codes include fluoroscopy and which fluoroscopy code is most appropriate to use. In October 1991 the ACR published an article in the Radiology Business Management Association (RBMA) magazine, the RBMA Bulletin, which explained when fluoroscopy was considered included in the study performed and when it was to be coded separately. 

For many radiologic procedures, fluoroscopic guidance is the radiologic technique by which images are produced. Therefore, in coding these services, one must be able to differentiate those procedures in which fluoroscopy is included in the service from those services in which it is not. 

When the ACR physician panels met to assemble the radiology Relative Value Scale (RVS), they were instructed to value all aspects of the radiology and radiation oncology procedure in question. This included assigning relative values to the radiologic modality used in imaging. Therefore, fluoroscopy is considered a part of such procedures as gastrointestinal exams, arthrography, myelography, cholecystography, venography, angiography, arteriography and cystography and is not coded separately. A general rule of thumb is if fluoroscopy is always performed as part of the radiological imaging study, fluoroscopy is included in the radiologic procedure code. 

CPT® fluoroscopy codes 76000 (up to 1 hour physician time) and 76001 (physician time greater than 1 hour) are intended for use as stand-alone codes when fluoroscopy is the only imaging performed. The most common scenarios include imaging that is not described by a separate supervision and interpretation (S&I) code and when a radiologist assists another physician in the performance of a procedure. 

The following clinical examples illustrate when fluoroscopy is used as a stand-alone code. 

1. A patient presents to the radiology department with a prior chest X-ray that suggests a focal density overlying one lung. The radiologist uses fluoroscopy to confirm or deny the density and, if density is present, to determine if it is in the lung tissue, rib or overlying chest wall soft tissues. Since fluoroscopy is the only imaging procedure performed at that patient encounter, CPT® code 76000, fluoroscopy less than 1 hour, is coded. 

2. A patient presents to the radiology department with a prior joint X-ray series, which demonstrates a calcified body near the joint. The radiologist uses fluoroscopy with the joint flexed, extended and rotated to determine if the calcification is indeed loose within the joint. Again, since fluoroscopy is the only imaging performed, CPT® code 76000 would be used. 

If the radiologist provides fluoroscopic guidance for a procedure done by another physician for which there is no S&I code (e.g., a radiologist assists a surgeon attempting to remove a radio-opaque foreign body), the code used would depend on the time spent in assisting the other physician (76000 for up to one hour, 76001 for more than one hour). 

In the above examples, there is both physician work and technical expense in providing the fluoroscopic service. Fluoroscopy requires personal supervision, i.e., the physician must be in attendance in the room during the performance of the procedure. If the radiologist is not present in the room during a fluoroscopic imaging procedure, neither CPT® code 76000 nor 76001 should be coded. 


Fluoroscopy codes were relocated within the CPT® 2007 code book as part of an American Medical Association organizational restructuring (CPT® -5 Data Model Project) to facilitate computer processing and interoperability with various computer systems. Therefore, the fluoroscopy codes that previously were listed under “Other” of the CPT® code book were relocated to a new section appropriately titled “Radiologic Guidance.” 

Code 75998 was renumbered 77001. This code describes the imaging associated with fluoroscopic guidance used for central access device placement, replacement, or removal. Unlike the other fluoroscopic guidance codes, this is an add-on code because the physician performing the primary procedure is the physician providing the fluoroscopic imaging service. This fluoroscopic guidance code includes the fluoroscopy used to maneuver the guide wire and, subsequently, the catheter into central venous position. The contrast injection through the access site and the mapping of the appropriate path are included. If spot films or other radiographic images are obtained to confirm final catheter position, they are also included.1 

Codes 76003 and 76005 were renumbered 77002 and 77003, respectively. Code 77002 is used to describe fluoroscopic guidance for all types of needle placement, i.e., biopsy, aspiration, injection, or localization device. Code 77003 is used to describe the fluoroscopic guidance and localization of a needle or catheter tip for spine or paraspinous injection procedures. 

For more detailed information on fluoroscopy and how to properly code the use of fluoroscopy, please consult the following references: 

AMA CPT® Assistant, Coding Clarification: Fluoroscopy — 76000, 76001, 77001, 77002, and 77003, June 2008. 

AMA CPT® Assistant, Coding Brief: Fluoroscopic Guidance with Epidurography and Sacroiliac Joint Arthrography, July 2008. 

AMA/ACR Clinical Examples in Radiology, Summer 2006: 8. 

ACR Radiology Coding SourceTM, 2007 CPT® Code Update, September/October 2006. 

1ACR Radiology Coding SourceTM, Major Restructuring of Central Venous Access Codes for 2004, November/December 2003.