Urology Coding Alert

Question: A urologist places a nephrostomy catheter under ultrasound (US) and fluoroscopic guidance. A separate radiologist interpreted the US imaging and fluoroscopic guidance. How should I code for both providers’ services?

Alabama Subscriber

Answer: This is a confounding example without much historical precedent to offer a definitive answer. For radiological supervision and interpretation (RS&I) services in which one provider supervises and another interprets, there are guidelines in place in which the Centers for Medicare & Medicaid Services (CMS) advises that both providers append modifier 52 (Reduced services) when reporting the fragmented CPT^® code.

In this instance, one provider has a known CPT^® code to report: 50432 (Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/ or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation). Since the physician is not reporting the full scope of this code, they will add modifier 52 to 50432 and include the appropriate documentation to explain to the payer what services were performed and what services are missing so the payer can reimburse accordingly.

For the radiologist’s role, there is no unlisted RS&I code to report, nor would you be allowed to append modifier 52 to the unlisted code to indicate the supervision portion of the service was not performed. Instead, your only working option is to submit 50432 and append the same modifier 52 as the urologist did for their service. You should submit this claim on paper, including an operative note, the radiological interpretation report, and a written description of the radiologist’s involvement.