Urology Coding Alert

Question: I’m looking for advice on how to bill a looposcopy (stoma access) and loopogram. I am billing 52005 and 74425 but am not sure whether this is correct. Do you have any suggestions?

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Answer: The 2016 CPT^® manual states, “Because cutaneous urinary diversions utilizing ileum or colon serve as functional replacements of a native bladder, endoscopy of such bowl segments, as well as performance of secondary procedures can be captured by using the cystourethroscopy codes …”

Therefore, you should bill the following codes for your clinical scenario:

• 52000 (Cystourethroscopy [separate procedure]) for the looposcopy through stoma
• 50690 (Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service) for the performance of the loopogram
• 74425 (Urography, antegrade [pyelostogram, nephrostogram, loopogram], radiological supervision and interpretation) for the radiological supervision and interpretation of the loopogram if interpreted by the urologist and documented in the medical record. Also append modifier 26 (Profes­sional component) to 74425 if these services are performed in hospital.