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Can you bill 52005 with 52204?

  1. #1
    Question Can you bill 52005 with 52204?
    Medical Coding Books
    I need clarification on billing 52005 with 52204. The Urologist dictated that he performed "Cysto, Random Bladder Biopsy and Bilateral Retrograde Pyelogram"

    He also dictated that he performed bilateral retrograde pyelograms.
    On the radiology report the Radiologist signed off that he had reviewed and signed the pyelogram. Does this mean the Urologist performed the test and the Radiologist read it? How should I code this. Should I use a modifer?



  2. #2
    Albany, New York
    In this case, both codes can be billed (Medicare considers 52005 a component [that is allowed if an appropriate modifier is present]
    of the comprehensive 52204). Add "59" to 52205.
    In 52005, the surgeon in instilling contrast material that will assist in the imaging (pyelogram) done by Radiology--CPT 74420
    Karen Maloney, CPC
    Data Quality Specialist

  3. Smile
    I agree with magnolia1. You can code 52204, 52005-59 (if you can justify the modifier) and then retrograde pyelogram 74420. Yes, you must use modifier 26 if you doc performed the test. The radiologist will bill for the readinig with a modifier TC on his bill.

  4. Question
    What if you were the ASC who owed the equipment & the tech came over from the xray dept to assist with the machine? Billing for the ASC, could you bill the 74420 -TC ? Also are you required to have some kind of film in the chart or is documentation in the op note enough for the ASC to bill the 74420 ?

    thank you for any and all imput.


  5. #5
    Omaha, Nebraska
    I believe you have the modifiers turned around...the radiologist reading/ interpreting the results would bill with modifier - 26 for professional services...the doc performing the test would bill with modifier -TC.....
    Carolyn Kohler, CPC
    Omaha, NE

  6. #6
    Omaha, Nebraska
    Yes, if the ASC owned the equipment, you would bill with modifier -TC ...and there should be an image available somewhere in the chart..either a hard copy if you use a paper chart system still or a scanned image if you have EMR/EHR...
    Carolyn Kohler, CPC
    Omaha, NE

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