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Retrograde Pyelogram - My question is how

  1. #1
    Barren River Area
    Exclamation Retrograde Pyelogram - My question is how
    Medical Coding Books
    My question is how do I decide if it the retrograde pyelogram is completing a procedure and I can not bill vs when I can bill. My doctors do it a lot to check placement of catheters, etc. In those cases can I bill it?
    Also I read somewhere you have to have a separate dictated report, but my doctors just put it in the op report with the cysto but has the findings dictated within the note.

    Brief op note example: Taking to operating room. Positioned pt. Performed cysto with 21 french ACMI cystoscope. Guidewire aided with catheter was advanced. Guidewire was removed but no fluid was obtained. Therefore a retrograde pyelogram was done to make sure that we were in the right place. On retrograde pyelogram it confirmed good placement of catheter. The catheter weas advanced to the pelvis of the kidney and some urine was taken and sent to culture. Following this guidewire was replaced and catheter was removed. A 6-French x 24 centimeter Microvasive double J stent was placed. Pt was awakened and taken to recovery room in good condition.

    Any answers would be greatly appreciated we all have mixed thoughts here.


  2. Cool
    I'm looking at using a cpt of 74420 but also couldn't decide against the 74400 but the tomography threw me off, so my answer would be 74420.

  3. #3
    For this we bill 52332 and 74420-26/59 for this procedure.

  4. Default
    Personally, I would not bill 74420, 26 in this example. In my opinion it does sound like the doctor is checking their work and there are no results dictated to what pathology was found during the retrograde pyelogram, for example, hydronephrosis, calcifications, filling defect, etc.

  5. Default Differnce between CPT 74420 AND 74400
    I have a question, these two CPT codes confuse me alot (please note: will add modifier 26 since billing for providers charge)

    ex: Doctor dictates right retrograde pyelography (along with the Cysto) I thought that pyelography meant it was being injected into the vein of the patient but there is no mention the contrast is being injected into the patient so would I bill the 74420? So what is the difference between the two charges?

    Please help me! thanks, Elizabeth

  6. #6
    Omaha, Nebraska
    Default Retrograde Pyelogram
    No, the contrast is not injected into the vein of the is injected through the catheter(s) placed via a cystoscope into the ureters - I believe. But, I'm also struggling with the retrograde pyelogram code 52005 ..that's the placement of the catheters ..CPT defines it as UNILATERAL or BILATERAL. For unilateral procedures I've been adding either -LT or -RT depending on which side the contrast is injected. I've been told this is not appropriate. Yet, if you search this topic and find my initial post - someone else stated they were told at a Medicare seminar that the -LT or -RT was, in fact, appropriate - I mean if the work RVU's take into consideration one side or both - and ICD-10 has made a big deal about laterality - why wouldn't you want to let the carrier know if you only did the pyelogram on one ureter? I'm so confused. I'm pretty confident, however, about your question.

    PS - earlier in this thread someone indicated using 52332 ...I would not use that code as it is for a stent exchange. I believe your physician is doing a retrograde pyelogram.
    Carolyn Kohler, CPC
    Omaha, NE

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