Urology Coding Alert

Question: I'm seeing multiple posts on coding sites about coding a bilateral retrograde with the usual bilateral modifiers. But how is it coded when the procedure is unilateral? Should I assign the correct modifier based on which side was injected with contrast?

Kentucky Subscriber

Answer: According to the latest CMS coding guidelines, modifiers RT (Right side), LT (Left side), and 50 (Bilateral procedure) to indicate a bilateral procedure are not allowed or accepted by Medicare carriers when billing code 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) bilaterally. While this may seem counter-intuitive, the procedure is technically categorized as a bladder procedure, not a procedure on the ureters. For Medicare carriers regardless of whether the retrograde pyelogram is unilateral or bilateral, you should only report one unit of 52005 (with no modifier) along with the 74420 (Urography, retrograde, with or without KUB) or 74420-26 as appropriate. For non-Medicare carriers, include modifier 50 to indicate bilateral retrograde studies as opposed to Medicare rules, and add one unit in box 24G of the 1500 form or in an equivalent space in the EHR.