Wiki Retrograde Pyelography

[angieanders77@yahoo.com]

Hello,
I was looking for some guidance regarding cpt code 74420- Urography, retrograde, with or without KUB. I have a provider i am auditing and they performed 52005-Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service and also provided interpretation and billed 74420-26 x 2 units. I have researched this and have not found much regarding the units. The MUE for this code is 2. Interpretation supports it was performed bilaterally , however the bilateral indicator for 74420 is "0". My question is since the code has an allowable MUE of 2 is it appropriate to bill the interpretation as 74420-26 x 2units when performed bilaterally? I have looked and looked and have been unsuccessful finding anything on this code relating to the allowable MUE.
Any input is greatly appreciated.

 

[julieordway]

You would not append any bilateral modifiers or bill for 2 units. According to the Medicare fee schedule, 74420 has a zero bilateral indicator. This means that bilateral surgery rules do not apply. You would only bill 74420-26 if your provider provided interpretation.

 

[angieanders77@yahoo.com]

that’s what I thought but it has an allowed MUE of 2. I forgot this point but it was billed in ASC SETTING and was performed bilaterally. I did more research and due to it being bilateral inductor 0-150% fee would not be applicable. But to report bilateral procedures in the ASC for Medicare you would put 2 units in. Had the MUE been 1 I would say would only be 1 unit. Regardless it won’t change the payment because of the bilateral indicator so it would be ok to place 2 units to accurately reflect the services provided (since it has an MUE of 2) is the conclusion I came up with.

Thank you for responding and if you totally disagree please feel free to respond.