Urology Coding Alert

Question: When a radiologist performs a voiding urethrocystography (VUCG) or a cystography and inserts a catheter, what is the appropriate way to bill this combination? We are currently billing 51600 for the injection procedure, 53670 for the cath insertion and either 74430 or 74450 for the supervision and interpretation of the cystography.

Ricardo J. Garcia, CPC, CEO
DRG Associates Consulting Group, Denver, Colo.

Answer: The catheter insertion (53670) cannot be billed with the cystography (51600) under the correct coding initiative (CCI) edits because it is impossible to perform a cystography without a catheter. If you have performed a cystography, bill 74430 (cystography, minimum of three views, radiological supervision and interpretation) with 51600 or 51605 (injection procedure and placement of chain for contrast and/or chain urethrocystography). If you are performing 74450 (urethrocystography, retrograde, radiological superivison and interpretation) bill with 51610 (injection procedure for retrograde urethrocystography). And if you're billing 74455 (urethrocystography, voiding, radiological supervision and interpretation) bill with 51600. If these procedures are performed in a hospital setting than the physician should append a -26 modifier to all of the 7000 codes.

Tip: Generally, CPT codes from the radiology section (70000 series) and laboratory section (80000 series) and medicine section (90000-99199) can be used with any other code without modifiers.