If you’re seeing Firefly or ICG in the operative note, don’t let it disappear into the documentation. It could represent an additional reportable service.
A Common Audit Miss
Indocyanine Green (ICG) fluorescence imaging is increasingly used during cholecystectomy to help visualize the major extrahepatic bile ducts during surgery. Yet this is a service that can be easy to overlook when reviewing the operative note.
When the documentation supports its use, HCPCS code C9776—intraoperative near-infrared fluorescence imaging of major extrahepatic bile ducts with IV administration of ICG—should be reported in addition to the appropriate cholecystectomy CPT code.
And this isn’t just a theoretical issue. ICG reporting is a recurring finding in surgical coding audits.
Know What to Look For
The operative note may not spell out “intraoperative fluorescence imaging.” Instead, coders may see references to:
- Preoperative injection of ICG
- ICG administered at the beginning of the procedure
- Use of the Firefly system
These details should prompt a closer look at whether C9776 is supported.
ICG ≠ Cholangiogram
One important distinction: ICG fluorescence imaging should not automatically be treated as an intraoperative cholangiogram. ICG is often used to aid visualization and dissection of biliary anatomy rather than to perform a cholangiogram.
The Takeaway
Don’t let a brief mention of ICG—or a reference to Firefly—get overlooked. When supported by the documentation, C9776 is an add-on code that belongs alongside the cholecystectomy code.
A simple review for ICG, fluorescence imaging, and Firefly terminology can help catch this surprisingly common coding miss.
Sources: Coding Clinic for HCPCS, 1Q 2022, pp. 9–10; Coding Clinic for HCPCS, 2Q 2023, p. 19.
Meet the Presenter: Tommi Mooney, MS, RHIA, CCS
Tommi brings ten years of experience in coding and auditing to the team as a Senior Coding Quality Auditor. Her career began as a Hospital Coding Specialist, where she quickly advanced through various roles, ultimately becoming the Director of Coding over Internal Audits and Education. In each of these positions, Tommi honed her skills in coding, auditing, and compliance. Throughout her career, Tommi has overseen internal audits, developed educational resources for coding professionals, and provided guidance to ensure coding accuracy and compliance across departments. Her leadership and dedication to improving coding quality have made her a key contributor to the team, where she provides audit oversight and coding expertise to support clients.
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