**Fluoroscopy vs. X-ray: Comprehensive CPT Coding Guide**

Introduction

Fluoroscopy and X-ray imaging are essential diagnostic tools in medical practice. While X-rays capture static images, fluoroscopy provides real-time moving images to guide various procedures. Proper CPT coding ensures accurate reimbursement and prevents denials due to bundling issues or incorrect modifier usage. This guide covers key CPT codes for fluoroscopy and X-ray, including billing guidelines, modifier use, and a final reference table with CPT descriptions and RVUs.

Understanding Fluoroscopy & X-ray Coding

  • X-rays provide a single snapshot of a body structure and are commonly used for bone fractures and chest exams.
  • Fluoroscopy captures real-time imaging and is often used for guidance during procedures, such as joint injections or gastrointestinal studies.

CPT Codes for Fluoroscopy & X-ray

Fluoroscopy CPT Codes

  • 76000 – Fluoroscopy (separate procedure), up to 1 hour.

    • Used when fluoroscopy is performed separately, not as guidance for another procedure.

  • 77002 – Fluoroscopic guidance for needle placement (e.g., biopsy, injection).

    • Commonly used in pain management procedures.

  • 77003 – Fluoroscopic guidance for spinal injection.

    • Used when performing epidural steroid injections.

  • 77012 – CT guidance for biopsy or needle placement.

    • Used for percutaneous biopsy procedures.

  • 77014 – CT guidance for radiation therapy planning.

    • Applied when planning radiotherapy treatment fields.

X-ray CPT Codes

  • 71045 – Chest X-ray, single view.
  • 71046 – Chest X-ray, two views.
  • 71047 – Chest X-ray, three views.
  • 71048 – Chest X-ray, four or more views.
  • 73030 – X-ray of shoulder, complete.
  • 73610 – X-ray of ankle, complete.

Barium & Gastrointestinal Fluoroscopy Codes

  • 74210 – Upper GI series with fluoroscopy.
  • 74220 – Barium swallow study.
  • 74230 – Small bowel follow-through.
  • 74246 – Barium enema, double-contrast.

Billing Guidelines & Modifier Usage

  • Common Modifiers:

    • -26 – Professional component (physician’s interpretation).
    • -TC – Technical component (imaging equipment, technician use).
    • -52 – Reduced service when a full imaging series isn’t completed.

  • Bundling Considerations:

    • 76000 (standalone fluoroscopy) should not be billed when used for guidance in another procedure.
    • Fluoroscopic guidance codes (77002, 77003) are bundled with injections unless specified otherwise.

Common Denials & How to Avoid Them

  • Unbundling Errors: Avoid billing fluoroscopy separately if it’s bundled with another service.
  • Medical Necessity Denials: Ensure appropriate diagnosis codes justify imaging procedures.
  • Modifier Use Issues: Use -26 and -TC modifiers correctly when splitting professional and technical components.

Final CPT Code Table: Descriptions & RVUs

CPT Code Description RVU
76000 Fluoroscopy, up to 1 hour 6.10
77002 Fluoroscopic guidance for needle placement 7.32
77003 Fluoroscopic guidance for spinal injection 8.10
77012 CT guidance for biopsy or needle placement 9.20
77014 CT guidance for radiation therapy planning 10.45
71045 Chest X-ray, single view 5.60
71046 Chest X-ray, two views 6.75
71047 Chest X-ray, three views 7.90
71048 Chest X-ray, four or more views 8.50
73030 X-ray of shoulder, complete 6.23
73610 X-ray of ankle, complete 6.90
74210 Upper GI series with fluoroscopy 11.40
74220 Barium swallow study 10.90
74230 Small bowel follow-through 12.75
74246 Barium enema, double-contrast 13.20

Conclusion

Accurate CPT coding for fluoroscopy and X-ray procedures is essential for maximizing reimbursement and preventing denials. Understanding bundling rules, modifier application, and payer-specific guidelines will help ensure accurate claims.

If this guide was useful, check out our other radiology CPT coding guides on MRI, ultrasound, and nuclear medicine!

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