Urology Coding Alert

Question: One of the urologists at our facility documented that while doing a scouting film and then with radiopaque contrast, he located a distal left ureteral stone. He then did a cystoscopy and retrograde ureteropyelogram that confirmed a filling defect in the distal left ureter. He proceeded to use a ureterscope to manipulate and remove the calculi from the ureter and then placed a ureteral stent. We’re coding from the facility standpoint. I know that 52005 is not reportable since it is bundled into 52352. Can we report 74415 along with 74420 for the urologist’s personal interpretation of the radiological studies?

Colorado Subscriber

Answer: Based on current edits from the National Correct Coding Initiative (NCCI), code 74420 (Urography, retrograde, with or without KUB) is a Column 2 code for 74415 (Urography, infusion, drip technique and/or bolus technique; with nephrotomography). Therefore, you cannot report both radiological interpretations at the same site on the same day during the same session. Your description of the encounter indicates that both interpretations (74415 and 74420) were performed on the same anatomical location. Because of that, you should only report 74415-26 (Professional services) for the reading of the X-rays.

In addition, submit 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)) and 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)). As you noted, 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) is not separately reportable because of an additional coding edit that bundles it with 52352.