# 52005 with 52204 ?



## Jody Mortensen (Oct 22, 2009)

I have the following op note that I could use assistance on. Urologist does a cystourethroscopy, bladder biopsies, bilateral ureteral washes & bilateral retrograde pyelograms with fluroscopic guidance & interpretation:  Procedure description: Cystoscope placed per urethra, urethra visually normal with slightly obstructing prostatic urethra.  His trigone was normal with orthotopic ureteral orifices & clear efflux bilaterally.  I first performed the right ureteral wash where I inserted the ureteral catheter into the right ureteral orifice & injected approximately 14 cc of sterile saline & allowed return to then drip into the cytology cup.  I performed the same procedure on the patient's left side, after which I performed retrograde pyelograms with a 6-French open-ended catheter & diluted Omnipaque contrast.  There were no filling defects.  I then performed serial bladder biopsies in the left/right bladder walls, dome, posterior wall & prostatic urethra.

Is my thinking correct on this procedure 52204 & 52005-59 for the surgeon.  The radiologists appears to have performed the test & read it & has charged 74420.  Please let me know your thoughts, any guidance would be appreciated. I'm also confused on 52005 & 74420 & cannot get my thinking straight on why both CPT's are allowable I don't understand the procedure done from each person:the surgeon with 52005 & the radiologist with 74420. If anyone could give me guidance I would appreciate it so much or a reference to get more information on.  Thank you in advance

                                          Jody Hecht


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## Kelly_Mayumi (Nov 5, 2009)

Hi Jody, when I run my CCI edits, 52205 and 52204 bundle, but a modifer is allowed.  I would probably not unbundle these codes depending on what the doctor was looking for.  Was the patient have hematuria or have a hx of bladder or kidney cancer?


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