You Be the Coder:
Fine Distinctions in Urography
Published on Fri Nov 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Why does CPT distinguish between IV bolus and IV for codes 74400 (Urography [pylegraphy], intravenous, with or without KUB, with or without tomography
) and CPT 74410 (Urography, infusion, drip technique and/or bolus technique
)? Does the type of IV alter the views?
Georgia Subscriber
|
Answer: Codes 74400, 74410 and 74415 can all be used interchangeably, with the exception that 74415 (Urography, infusion, drip technique and/or bolus technique; with nephrotomography) must have tomography done with the pyelogram. Not all facilities do tomograms on a routine basis.
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 74410 and 74415 remain valid codes and may continue to be assigned, many experts anticipate that they will eventually be eliminated.
The misunderstanding surrounding these codes often occurs because the description for 74400 includes reference to "intravenous" delivery of contrast material (while 74410 refers to "infusion, drip technique and/or bolus technique") and "tomography" (while 74415 specifies "nephrotomography").
Traditionally, for instance, radiologists would administer the contrast material using any one of a variety of techniques infusion, drip technique or bolus. If the technique was clearly stated in the medical report, a coder assigned 74410. If no technique was documented, 74400 was used. In recent years, however, virtually all IVPs have been performed using bolus injections, and the need to record a distinction has become moot as have most reasons 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. Tomography is a technique for taking radiographic images of an organ that shows specific slices or planes of the organ. Nephrotomography is simply an alternative term that specifically describes tomography as it applies to imaging of the kidneys.
In short, thanks to these imaging advances, experts say coders may feel comfortable disregarding these two outdated, inapplicable codes and using the most recently modified 74400 for all IVPs. | |
