Urology Coding Alert

Question: Our urologist performed a cystoscopy with a retrograde pyelogram to localize a stone for ESWL. Would it be appropriate to separately report the cystoscopy and retrograde pyelography when they were only performed for localization of the stone prior to the ESWL?


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Answer: Yes, you should report the cystoscopy and retrograde pyelography separately. First, report 50590 (Lithotripsy, extracorporeal shock wave) for the ESWL, since this is the more extensive procedure.

Next, report CPT 52005 -59 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation or ureteropyelography, exclusive of radiologic service; distinct procedural service) for the retrograde study to identify the stone. Add modifier 59 to unbundle 52005 from the ESWL. Because this is an independent procedure - certainly not performed each time an ESWL is performed - you may also code for it in this case.

Also, report 74420-26 (Urography, retrograde, with or without KUB; professional component) if the urologist read the x-rays and documented the radiological findings in the report.