# Cystourethroscopy with right retrograde pyelogram



## lovetocode (Feb 13, 2010)

What would the anesthesia code be for the primary procedure:

Cystourethroscopy with right retrograde pyelogram?

Would it be 01922?

Any comments would be appreciated.

Thanks, 

Jamie


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## aschaeve (Feb 15, 2010)

The CPT code 74420 for the retrograde pyleogram does not have a crosswalk to 01992 this year.  So you would just code for the procedure done.

Is this what everyone else is doing?

Alicia, CPC


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## AuntJoyce (Feb 15, 2010)

*Asa*

Your crosswalk code would be 00910.  The 74420 is the radiological supervision while 52005-7 represents your base procedure.


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## lovetocode (Feb 16, 2010)

Thank you for your comments.  With anesthesia, we can bill for the procedure with the highest base which would be the radiology code (74420 with an anesthesia code of 01922).  The anesthesia code 00910 has a base of 3 while 01922 is assigned a base of 7.  My confusion stems from the fact that I am unsure if we can bill for the radiology.  The retrograde pyelogram was a diagnostic procedure, therefore does this mean we cannot bill for the radiology code?

Thanks again for all comments.  

Jamie


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## lovetocode (Feb 16, 2010)

The radiology report states the procedure was a urography retrograde w/or w/o KUB.  It states the type of procedure was a diagnostic x-ray.  I spoke the surgeon and they only billed for the cystoscopy.  I also spoke with the radiologist and they billed 74420.  Any ideas?

Thanks again.


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## AuntJoyce (Feb 16, 2010)

First, I agree wholeheartedly that when billing for anesthesia, you do get to bill for the highest procedure.  However, the anesthesiologist is providing that anesthesia primarily for the surgeon and not the radiologist.  Therefore, I would err on the side of caution in the great ethics debate and not go with the radiological code.  That, in and of itself, is not the main procedure but simply the eyes into the body designed to make the invasive procedure "viewable"....just as the anesthesia make the procedure bearable for the patient.

Unfortunately, in coding, nothing is black and white - I am convinced that they write the rules and regulations simply to confuse us more than we already are.

Hope this helps 

Joyce


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## lovetocode (Feb 16, 2010)

GREAT POINT!!!  Thanks again for all your input.  It is always nice to be able to talk these issues out with other coders.


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## aschaeve (Feb 17, 2010)

I have an anesthesia article from 2005 Aneshtsia & Pain Management Coding Alert, that says you can bill 01922 for 74420 urography retrograde.  But this year you can no longer do that, because there is no crosswalk anymore for code 74420.

Alicia, CPC


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## lovetocode (Feb 17, 2010)

Couldn't we still charge for the 74420 if the retrograde pyelogram was performed?  With anesthesia, can't we still bill for the radiology code?

Thanks again everyone for your time and input.


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## aschaeve (Feb 18, 2010)

For Anesthesia you can not bill for the retrograde code 74420.  If you look in your 2010 Anesthesia crosswalk book, there is no longer a crosswalk code.  In the 2009 Anesthsia crosswalk it did crosswalk to 01922.  So I would only bill for the procedure that was done.

Alicia, CPC


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## lovetocode (Feb 18, 2010)

Thank you for all your responses.  My supervisor spoke with two of our doctors and both agreed that a retrograde pyelogram does not add complexity to the primary procedure (the cysto.), so therefore we are not going to charge for them.


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