# Unilateral Retrograde Pyelogram



## ckkohler (Dec 12, 2017)

I’m seeing a number of posts regarding a bilateral retrograde and not coding with modifier -50, -LT or -RT...but how are you coding when the retro is done on just one side? I’ve been assigning the correct modifier based on the side contrast was injected. Is this wrong? Thanks for the assist.


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## drewvinson23 (Dec 13, 2017)

Per AAPC's Procedural Coding Expert 2017, modifiers RT, LT and 50 are not allowed with CPT 52005.  While this may seem counter-intuitive, the procedure is technically categorized as a bladder procedure, not a procedure on the ureters.  Regardless if the retrograde pyelogram is unilateral or bilateral, you should only report one unit of 52005 (with no modifier) along with the 74420 or 74420-26 as appropriate.

Sincerely,

Drew Vinson
CPC
NW Urology


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## debbiesom (Dec 14, 2017)

I went to a Medicare seminar and for Bilateral Catheters 52005 I was instructed to bill as follows:
52005-RT
52005-XS,LT

I have tried this and both pay.
They will not pay 52005-50


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## ckkohler (Dec 26, 2017)

*Unilateral 52005*

That’s what I was thinking too Debbie. I understand that 52005 can be either unilateral or bilateral which is why I was wondering the -LT or -RT was not appropriate. Any thoughts?


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## thomas7331 (Dec 27, 2017)

Here is the guidance from the American Urological Association (see http://www.auanet.org/practice-reso...ation/stents-and-catheterization-procedures):

_CPT Code 52005 has a zero in the bilateral field (payment adjustment for bilateral procedure does not apply) because the basic procedure is an examination of the bladder and urethra (cystourethroscopy), which are not paired organs. The work RVUs assigned take into account that it may be necessary to examine and catheterize one or both ureters. No additional payment is made when the procedure is billed with bilateral modifier "-50." Neither is any additional payment made when both ureters are examined and code 52005 is billed with multiple surgery modifier "-51." It is inappropriate to bill code 52005 twice, once by itself and once with modifier "-51," when both ureters are examined.

Commercial carriers may have their own rules on coding bilateral retrogrades. Contact your carrier to determine their billing requirements._

This is a question that comes up frequently in the forum - if you do a search you'll find additional discussion.


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## ckkohler (Dec 27, 2017)

*Retrograde Pyelogram*

Thomas,
Thank you for your reply.  Just to clarify, I did search the forums prior to posting the question.  I checked again just now to see if I missed anything - and I do not find a post directly addressing my question.  Again, my question is not whether to bill 52005 bilaterally or not - but IN the event it is done on just ONE side, IS it appropriate to add the -LT or -RT to signify BOTH ureters were not injected with contrast.  Do you agree or disagree with Drew's point of view that a retrograde pyelogram is a BLADDER procedure and NOT a ureteral procedure?  Thanks.


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## thomas7331 (Dec 27, 2017)

Sorry, didn't mean to imply you hadn't searched first, it's just that I thought I'd recalled this bilateral vs. unilateral discussion coming up a number of times in the past.  Well, to answer your question, since the procedure involves both bladder and ureters, I wouldn't agree that is correct to say that it is one or the other, but I'll defer to the sources cited.  Regarding the use of the LT/RT modifier, in my opinion and based on my own experience with payers, these modifiers are informational and don't affect payment other than to distinguish the procedure from others that might have been billed on the contralateral side.  So I don't see anything wrong with adding it and since there is a ureteral component it seems self-evident what the modifier would signify.  However, from the forum discussion I have noticed that a lot of coders seem to have had different experience than I have, in that some payers appear to be more strict about the use of these modifiers and may or may not allow or require them.  But the bottom line is that it shouldn't really matter - as the AUA points out, the RVUs for this code have been set to account for the fact that the procedure is sometimes performed on one side and sometimes on both, so it should not be necessary to indicate this unless the a payer is requiring it for some other reason.  Hope that helps some.


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## ckkohler (Dec 27, 2017)

Thomas, 
Thank you for your opinion.  I am of the same...since the -LT and -RT are informational ONLY, I don't see the harm in entering them.  It does signify to the payer that only ONE side was done.  It was a very new coder (a CCS not a CPC) who brought it to my attention it was not appropriate.  The supervisor agreed with her .. yet, a seasoned coder agreed with me.  We've always said we felt we had to code according to our conscience - and it just makes common sense to me (if I ever had to defend it) - that the adding of the laterality modifier explains to the payer we didn't do an "entire" procedure.  It probably is neither here nor there - but, at least I've done my part to honestly notify the carrier it was a unilateral procedure.  Thanks again for the assist!  Happy New Year to you!


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