Urology Coding Alert

Question: When billing for a retrograde pyelogram, should I charge for the injection of the contrast? If so, which code should I use? Also, which code should I use for the pyelogram?


Nebraska Subscriber

Answer: The retrograde pyelogram involves two distinct procedures. CPT code 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) represents the catheterization of the ureters and introduction of contrast material. The urologist or radiologist may also interpret the images (x-ray films or fluoroscopic images) and report 74420 (Urography, retrograde, with or without KUB).

For any retrograde pyelogram, you can report 52005 for the urologist's work. However, reporting 74420 depends on who interprets the study, and where this occurs.

What to do: If, in the hospital with a radiologist, the urologist introduces the contrast, takes the x-rays, reads the films and acts clinically according to his interpretation, report 52005 for the cystoscopy and retrograde pyelogram and report 74420-26 (Professional component) for the interpretation of the x-rays.
 
If the urologist performs both the cystourethroscopy and the urography in his office using equipment that heowns, you can report both 74420 and 52005 without any modifiers.

Don't miss: The charge for injection of contrast material is included in 52005. CPT code 50684 (Injection procedure for ureterography or ureteropyelography through ureterostomy or indwelling ureteral catheter) is bundled into code 52005. Unbundling is allowed with modifier -59 (Distinct procedural service) if the urologist performs a ureteropyelogram through the retained indwelling ureteral catheter at another encounter on the same day.