When to use (or not use) 74420

[pchamp25]

I need help in regards to when 74420 should be used and when it shouldn't. Pt had cystoscopy , ureteroscopy w/laser lithotripsy and ureteral stent insertion. We billed 52356-50 and 74420-TC to the ins and the insurance denied 74420-TC. I am still unsure when to use 74420 over 52005. Any help would be greatly appreciated! Pam

 

[SharonCollachi]

Have you read this LCD? It may not apply to you specifically, but it may answer your questions.

 

[thomas7331]

You'll notice in CPT that the code description for 52005 states that this is 'exclusive of radiologic service', so 52005 only includes the procedure of the catheterization, not the imaging. 74420 is used to report the radiologic service separately for the urography or pyelography, if performed. In other words, if the provider documents the injection of dye and taking of images, you would report the 74420-TC for the imaging (and 74420-26 if the provider documents an interpretation and report).

In your example above, you cannot report 52005 because the catheterization is an incidental and bundled component of 52356. But if urography or pyleography was performed in addition to the other procedures you list above, then you may report 74420 because the radiologic portion is not bundled.

 

[pchamp25]

Thank you! That helps a lot