Urology Coding Alert

Question: We sent a patient for X-rays of his kidney, ureters and bladder (KUB). The patient brought the films back to our office, and during the office visit the urologist read the films and dictated his findings. Can we bill for the KUB with modifier -26? Kentucky Subscriber Answer: Unfortunately, probably not. The radiologist at the X-ray facility will also likely interpret the result of the KUB, unless you already have a special agreement in place. In some cases, if the urologist is doing a procedure in the facility (such as a retrograde pyelogram) and he interprets it and provides a separate document for the results, you can bill for the professional component.

For example, you can bill 74420-26 (Urography, retrograde, with or without KUB; professional component), with modifier -26 signifying that the urologist only interpreted the test but does not own the x-ray equipment or pay for the technician or the contrast material. But even in that scenario, there will probably be issues with the radiologist, who may also bill for the interpretation after the fact. That would result in duplicated claims for the same service by two providers. The interpretation of results in the scenario given would be included in the Data portion of the "Medical Decision-Making" of that E/M documentation for the service that day. Most often, a KUB would be a "simple" data point, although some have argued that the KUB might represent a "complex" data point. More complex data might lead to a higher level of medical decision-making, which in turn might lead to a higher-reimbursing E/M code for the visit.