Wiki urology coding question

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tmorehart

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Can I please get some feedback from those who code urology on a regular basis? I am billing the radiology profees only and feel that this is being coded incorrectly. This is being coded 74020, 74420-RT, 74420-LT. Any feedback would be greatly appreciated.

Below is the report in question.

Retrograde pyelogram. Radiography for ureteral stent placement.

Indication: Distal ureteral stricture.

Findings:

Retrograde pyelogram: The distal ureter was opacified with contrast material via a ureteral catheter.

This demonstrates a short but tight distal ureteral structure. The structure is located at the level of the mid pelvis. Precise measurements cannot be obtained on these images for technical reasons.

The ureter appears to be slightly distended proximal to the stricture.

Radiography for stent placement: A single image demonstrates a right ureteral stent extending from the presumed level of the renal pelvis to the urinary bladder. No other abnormality is seen.

Impression:

1. Short tight distal ureteral stricture demonstrated on retrograde pyelography.
2. Right ureteral stent present on final image extending from level of renal pelvis to urinary bladder.
 
The code 74420 includes a 74020. The report states that a ureteral cath was inserted and a ureteral stricture was detected, they would have performed the radiography to know that the stricture was there.

With that said. there is no indication from you provided that this was done bilaterally, there is only the mention of the RT side. Therefore the report leads me to believe that only the right side was cath'd and viewed.


The correct coding from this document "in my opinion :)"
is only the 74420-RT.

Now if both sides where in fact viewed, then the report needed to be amended to show that and then you would code it as: 74420-RT, 74420-LT.

I hope that this helps. Good Luck!!!
 
Thank you so much for your reply. I agree with your opinion, however I am questioning the use of the RT and LT modifiers in general. From some of the information that I have found it states RT, LT and 50 modifiers are not valid for this CPT code. If that is the case then how do I properly code if they are viewing both sides?
 
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