Urology Coding Alert

Question: Our urologist inserted a Rutner catheter into the left ureteral orifice and instilled a hypaque material under fluoroscopic guidance. Outside of some narrowing of the distal ureter, the urologist documented normal anatomy within the rest of the ureter and bladder. How should I code for these services?

Washington Subscriber

Answer: The exam header for this procedure should include something along the lines of a diagnostic cystourethroscopy with a retrograde pyelogram. Furthermore, the body of the report should include documentation of the urologist inserting a catheter (cystourethroscopy) and injecting contrast under fluoroscopic guidance (pyelogram) in order to explore the ureter and bladder for anomalies that might tie back to the patient’s preoperative diagnosis.

As for coding, you want to report the correct cystourethroscopy code that includes ureteral catheterization: 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service). Furthermore, since 52005 does not include radiologic service, you may report the interpretation of the retrograde pyelogram separately using code 74420 (Urography, retrograde, with or without KUB). Assuming your urologist does not own the imaging equipment, attach modifier 26 (Professional component) since your urologist only performed the review and interpretation portion of the pyelogram, not the technical portion.

However, you should only code for the interpretation (reading) of the retrograde pyelogram if the urologist performs the radiological supervision and interpretation (RS&I) portion of the study. In many cases, the RS&I will be performed by a separate radiologist, in which case, the urologist exclusively reports code 52005. Expect the hospital or outpatient facility to bill for the technical component of the service unless the urologist owns the imaging equipment.