Urology Coding Alert

Question: A physician does a pyelogram on both the left and right side ureter. Can I code both? I'm reporting the pyelogram along with code 52332-50 for a bilateral stent insertion. I see that modifiers 50/LT/RT are not allowed with 74420-26. Does that mean I can bill it only once per session? Also, if the urologist does a retrograde pyelogram to "verify" what was done during a procedure, can I bill for it or is it considered part of the primary procedure?

Washington Subscriber

Answer: The Correct Coding Initiative (CCI) bundles a retrograde pyelogram (52005, Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiological service) into 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]), and you cannot unbundle this edit.

For your clinical scenario you should report the following codes:

• 52332 for the stent insertion;

• Append modifier 50 (Bilateral procedure) to 52332 since the stent insertion was bilateral; and

• 74420 (Urography, retrograde, with or without KUB) if your urologist interpreted the films and wrote a radiological report.

Remember to append modifier 26 (Professional component) for the interpretation of the pyelogram. The hospital or facility will bill the technical portion (modifier TC) of the pyelogram. You may bill this radiological service only once per session. Payers will consider a retrograde pyelogram at the conclusion of a procedure to verify what was done as part of the procedure and not a separately billable service.