Choosing the Correct Code From Urography Series Optimizes Reimbursement for IVPs
Published on Mon May 01, 2000
Pyelography is frequently used to localize and diagnose disorders of the urinary tract such as kidney stones (ICD-9 Code 592.0, calculus of kidney), and CPT Codes provides a series of codes to describe various techniques used during these procedures (74400-74425). However, many professional coders express confusion about which code to use under which circumstancesand with good reason. The distinctions between them are slight and in some cases do not reflect changes in clinical techniques used during intravenous pyelograms (IVPs).
I simply dont understand this series of codes, the director of one coding department exclaims. The definitions are so closely related that its nearly impossible to know when one should be used as opposed to another. In most cases, my coders fall back to 74400 (urography [pyelography], intravenous, with or without KUB, with or without tomography). Im not sure if this is a correct strategy and would like to get a grasp of these codes.
According to many experienced coding professionals, using 74400 as a catchall code to describe IVPs is entirely appropriate. It was revised several years ago to encompass virtually all aspects of these urography procedures, and most payers reimburse it accordingly. Although CPT 74410 (urography, infusion, drip technique and/or bolus technique) and 74415 (with nephrotomography) remain valid codes and may continue to be assigned, many experts anticipate that they will be eliminated when CPT 5 is published.
Deciding When to Use 74400, 74410 or 74415
The misunderstanding surrounding these codes often occurs because the description for 74400 includes references to intravenous (as does 74410 [drip technique]) and tomography (as does 74415). Its understandable that there has been confusion, says Brian Effron, CHBME, of Healthcare Administrative Partners in Media, Pa., which provides medical billing and practice management services in seven states and also has offices in Newton, Mass., and Portsmouth, N.H. Code 74400 clearly incorporated elements of 74410 and 74415.
Coders report that the uncertainty about assigning these codes has escalated during the past few years as CPT code revisions have not kept pace with the rapidly changing environment of medical imaging.
Traditionally, for instance, radiologists would administer the contrast material using any one of a variety of techniquesi.e. infusion, drip technique or bolus. If the technique was clearly stated in the medical report, a coder would have assigned 74410. If no technique was documented, 74400 would have been used. In recent years, however, virtually all IVPs have been performed using bolus injections and the need to record a distinction has become mootas has any reason to assign code 74410.
In addition, specific use of 74415 has become unnecessary, for the simple reason that the terms tomography and nephrotomography can be used interchangeably, Effron points out. Tomography is a [...]
