Radiology Coding Alert

Diagnostic studies of the bladder and urethra are frequently ordered to detect anatomic or functional abnormalities of the lower urinary tract. Cystography is performed when the ordering physician wants to examine the bladder, which collects and stores urine after the kidneys have processed it. Different types of urethrocystography may be performed when conditions involving the urethra, the tube leading from the bladder to the outside of the body, are also suspected. Besides the imaging, radiologists may also report a variety of contrast injection procedures, if they performed these services.
Coding Studies of the Bladder 
Cystography allows the radiologist to view the bladder "" explains Patti Offner RT with Diagnostic Imaging Inc. in Philadelphia. ""The bladder is emptied immediately before the procedure and a catheter is inserted through the urethra into the bladder. Once the catheter is in place the radiologist will fill the bladder with contrast material.""
 
During a typical session abdominal x-rays will be taken before and while the bladder is filling with contrast. Voiding and postvoiding radiography images may also be obtained. According to Chris Sari CPC RCC quality assurance manager for Advanced Radiology in Baltimore fluoroscopy may be used with standard x-rays.
 
The imaging portion of the procedure is reported with 74430 (cystography minimum of three views radiological supervision and interpretation) Offner says with the radiologist obtaining multiple images. ""This may occur for a number of reasons. Because of the patient's condition it may take time for the bladder to fill properly or it may take time for the patient to void the bladder. And the radiologist usually wants films after the bladder has completely emptied because the residual volume may provide valuable information."" No matter how many images are obtained 74430 is reported only once. Delayed films are considered part of the overall study and may not be reported separately.
 
Along with the imaging code radiologists who perform the injection of contrast media may also report that service with one of two codes: 51600* (injection procedure for cystography or voiding urethrocystography) or the rarely used 51605 (injection procedure and placement of chain for contrast and/or chain urethrocystography). CPT 51600 * is a starred procedure which means services include only the surgical procedure. Routine follow-up care is not part of a global package and may be reported separately.
 
One common error plagues coders when reporting cystography -- they also attempt to report the catheter-ization (e.g. 53670 catheterization urethra; simple). However catheterization is part of the surgical codes (51600 and 51605) and should not be reported separately. In fact if a catheter is already in place and that work is not done during the cystography modifier -52 (reduced services) should be appended to the surgical code.
 
Among the ICD-9 codes for cystography are [...]