Cut the Confusion: Billing for Retrograde Pyelogram- Published on Wed, Mar 01, 2000
Urology coders are often confused about what codes they can bill with 52005 (cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) when trying to get reimbursed for a retrograde pyelogram. Sometimes they want to bill a 52000 (cystourethroscopy [separate procedure]) along with the 52005, but that is not permissible, says Brenda Oliver, billing office manager for Pioneer Valley Urology, a six-urologist practice in Springfield, Mass. This is because 52005 includes 52000. The endoscope is inserted to perform the pyelography; the scope, catheterization, and pyelography are all included in 52005.
However, urology coders can bill codes 52005 and 74420 (urography, retrograde, with or without KUB) together to get reimbursed for a retrogade pyelogram, says Thomas A. Kent, CMM, president of Kent Medical Management in Dunkirk, Md. Code 74420 is the code radiologists use to read the pyelogram.
A pyelogram is an x-ray of the renal pelvis and ureter, following injection of contrast. A retrograde pyelogram occurs when the contrast material is injected into the ureters via an endoscope in the bladder. But there is no CPT code specifically for a retrograde pyelogram. The proper code to use is 52005. The phrase with or without is the key phrase in the CPT definition of the code. You are being paid for the endoscopy, and youre not going to get paid any extra for instillation of the contrast material. The procedure is done for cancer, cystitis, and obstructions.
Because theres no specific code for a retrograde pyelogram, you have to use 52005, says Oliver. Almost all of the commercial plans pay better for this code than Medicare does, Oliver notes.
Here are three examples of coding 52005 and 74420 together:
Example 1: The physician performs a retrograde pyelogram in the hospital with only a radiology technician to operate the equipment. This should be billed 52005 and 74420-26. The -26 modifier (professional component) indicates that the urologist interpreted the radiology results. This is a common situation.
Example 2: The urologist performs a retrograde pyelogram in the hospital with a radiologist present to interpret the results. In this case, the urologist would bill 52005 only.
Example 3: The urologist performs a retrograde pyelogram in his office or surgicenter using physician- owned equipment and a technician. Bill 52005 and 74420, with no modifiers. In this case the urologist gets the full amount for the radiology service because he owns the equipment and pays the technician as well as interprets the results. This would be the least common situation.
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