Radiology Coding Alert

Question: We received a claim denial for a nephrostogram procedure. We billed for the physician and the physician supervised the X-ray technician who performed the procedure. According to the lead technician, “The patient already has a nephrostomy tube in place before they came in to us. We don’t place them here at this facility. So we inject contrast into the nephrostomy tube they already have and then take some X-rays.” We originally billed 74425, but the claim was denied.

How can we correct the claim?

Florida Subscriber

Answer: You can correct your claim by billing 50431 (Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access) instead of 74425 (Urography, antegrade, radiological supervision and interpretation).

Code 74425 is no longer used to report a nephrostogram, as the procedure is now bundled into 50431 according to the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edit pairs. Code 50431 is the correct code choice since you’re billing for the doctor, who also interpreted the images, and the injection occurred through the patient’s existing nephrostomy tube.