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Thread: Retrograde Pyelogram - My question is how

  1. #1
    Join Date
    Apr 2007
    Barren River Area

    Exclamation Retrograde Pyelogram - My question is how

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    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. #2


    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
    Join Date
    Apr 2007


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

  4. #4


    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.

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