# CPT 74420 vs 52005



## bpiggott

Hello,

I need some help on coding a cystoscopy, right retrograde pyelogram, ureteroscopy w/stone extraction, & insertion of ureteral stent all in the same procedure.  

I have codes 52332 & 52352 for the stent & ureteroscopy w/stone removal.  But I'm unsure on whether to use CPT 74420 for the Retrograde Pyelogram or CPT 52005.  I've reade where it states to only use the 74420 unless there is a seperate report, not actually all in together on the same report as the cystoscopy.   But then I see where it states that 52005 is not billable with CPTs 52332 or 52352.

Any thoughts on this?

Thanks,
Beth


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## zaidaaquino

You are correct in that cpt cannot be billed as it is included in both 52332 and 52352.  

In regards to your other question about billing CPT 74420, per the American Urological Association/AUAnet: "If the retrograde is performed to complete the procedure, CCI considers the retrograde inherent to the endoscopy procedure performed.  *However*, if the physician performed the supervision and interpretation of the retrograde, the urogloist may bill 74420 [...].  If the physician does not own the equipment, a -26 modifier ust be appended to the 74420.  *A complete and separate report must be dictated with findings*."

Based on our own documentation, we typically bill 52352, 52332 -51, and 74420 -26.

Zaida, CPC
Urology Billing Office


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## bpiggott

Ok that makes sense.   Now if the other 2 CPT codes were billable with the 52005 we would just bill it instead of the 74420 code right?   Or would you use both?


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## ncantello

You mentioned a complete and separate report.  Is this something different then your op notes?  Do you mind sharing an example of what that report would look like?  I didn't realize we could possibly code the 74420.  Great information.

Thanks.


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## mbort

*cpt assistant*

Year: 2000 

Issue: September 

Pages: 11 

Title: Urinary System, 52005, 52330, 74420 (Q&A) 

Body: Coding Consultation

Question

What are the proper CPT codes to report cystoscopy with a retrograde pyelogram and cystoscopy with manipulation and retrograde pyelogram?

AMA Comment

From a CPT coding perspective, the most appropriate method of reporting a cystoscopy with a retrograde pyelogram (RPG) is with codes 52005, Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service, for the cystoscopy and 74420, Urography, retrograde, with or without KUB, for the radiologic portion of the retrograde pyelography. If the physician is only performing the professional component of 74420, then modifier '-26,' Professional Component, should be appended to 74420.

If a cystoscopy with manipulation and RPG were performed, then code 52330, Cystourethroscopy (including ureteral catheterization); with manipulation, without removal of ureteral calculus, would be reported in addition to codes 52005 and 74420, as code 52330 is considered to be a separate, distinct procedure which would be reported separately.

When multiple procedures or services are performed at the same session by the same provider, the primary procedure would be reported as listed in CPT. The additional procedure(s) or service(s) may be identified by appending the modifier '-51,' Multiple Procedures, to the additional procedure or service code(s).


© 2005 American Medical Association


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## ncantello

mbort,

Does the professional component modifier -26 just mean that someone else is reading the reports?


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## mbort

yes, the TC component is for whomever owns the equipment, and the 26 is for whomever is reading the study.  Most often when its done in combination with a cystoscopy, its the performing surgeon


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## ncantello

Thank you, you always clear things up!


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## ali082005

*ICD- 9 diagnosis procedure coding*

*ICD- 9 diagnosis procedure coding: How do you code:[/*COLOR] 
Cystoscopy with left retrograde ureteral pyelogram?
Thanks.


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