04/11/2023    Keith L. Gurnick, DPM

Post-Operative Fluoroscopic Scans as a Standard of Care? (Eddie Davis, DPM)

1) In response to Dr. Eddie Davis, who wrote, "My
lease stipulated that I could not have an x-ray
unit" and as a guide to our many doctors who might
be negotiating office space leases, that clause
was likely a boiler plate clause put in your lease
and anyone else in the building to protect the
radiologic group from competition at the same
property. When I signed my first office lease in
1980s, there was, and still is a radiology group
on the ground floor of my medical building. There
was a similar clause in the 22 page lease offered
to me that excluded me from taking x-rays.

We had a meeting and the property owners agreed,
because it was a restraint of trade and a
limitation of my scope of practice under my
podiatry license in the state of California. The
clause was justly omitted, and instead we added a
clause that "an x-ray machine and any necessary
equipment to process x-rays is allowed in my
office, but only to be used on the patients in and
of my practice." My advice, never let an outside
source limit your already limited license to
practice at the fullest scope of your professional
degree.

2) "Use of a fluoroscopy unit with flat panel
receptor for the purpose of static radiographic
images is billed as an x-ray, not a fluoroscopic
study." I'd suggest Dr. Davis get a legal opinion
on this statement, before telling 16,500 readers
that this is his billing protocol. I think he will
find many podiatry billing experts in disagreement
and he may be suggesting to our readers a billing
scenario that could be considered "fraud and
abuse". I think that an x-ray is an x-ray and
should be billed with an x-ray CPT code. An image
obtained with a fluoroscopy machine, whether
static, dynamic, non-weight-bearing or
somewhat weight-bearing is still a fluoroscopic
image, and probably should be billed as such.

Keith L. Gurnick, DPM, Los Angeles, CA

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