How To Use CPT Code 74420

CPT 74420 is a code used for retrograde urography procedures, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 74420?

CPT 74420 is a medical billing code used for retrograde urography procedures, which involve imaging the urinary tract by injecting radiopaque contrast material through a catheter against the normal flow of liquid into the kidney and ureters. This procedure is typically performed to investigate upper urinary tract obstructions and can be done with or without a diagnostic KUB (Kidney, Ureter, and Bladder).

2. 74420 CPT code description

The official description of CPT code 74420 is: “Urography, retrograde, with or without KUB.”

3. Procedure

  1. The patient is positioned on the examination table, and the area around the urethra is cleaned and sterilized.
  2. A local anesthetic is applied to the urethra to minimize discomfort during the procedure.
  3. A cystoscope is inserted through the urethra and into the bladder to visualize the ureteral openings.
  4. A catheter is inserted through the cystoscope and into the ureter(s) to be examined.
  5. Radiopaque contrast material is injected through the catheter, allowing the urinary tract to be visualized on X-ray images.
  6. X-ray images are taken to evaluate the flow of contrast material and identify any obstructions or abnormalities in the urinary tract.
  7. The catheter and cystoscope are removed, and the patient is monitored for any complications or adverse reactions to the contrast material.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 74420 services are those experiencing symptoms or have a medical history that suggests the presence of upper urinary tract obstructions or abnormalities. These may include recurrent urinary tract infections, hematuria (blood in the urine), flank pain, or a history of kidney stones. Additionally, patients with known or suspected urinary tract abnormalities, such as strictures or tumors, may also be candidates for this procedure.

5. When to use CPT code 74420

It is appropriate to bill the 74420 CPT code when a retrograde urography procedure is performed to investigate upper urinary tract obstructions or abnormalities. This code should be used in conjunction with other relevant codes, such as CPT 52005 for cystourethroscopy with ureteral catheterization, depending on the specific services provided during the procedure.

6. Documentation requirements

To support a claim for CPT 74420, the following information should be documented in the patient’s medical record:

  • Patient’s medical history and symptoms indicating the need for the procedure
  • Physical examination findings related to the urinary tract
  • Details of the procedure, including the use of a cystoscope, catheterization of the ureter(s), and injection of contrast material
  • X-ray images obtained during the procedure and their interpretation
  • Any complications or adverse reactions experienced by the patient
  • Diagnosis and treatment plan based on the findings of the procedure

7. Billing guidelines

When billing for CPT code 74420, it is essential to follow specific guidelines and rules to ensure accurate reimbursement. These may include the use of modifiers, such as 26 for the professional component or TC for the technical component, depending on the services provided and the setting in which the procedure is performed. Additionally, it is crucial to be aware of any payer-specific policies or requirements related to billing for retrograde urography procedures.

8. Historical information

CPT 74420 was added to the Current Procedural Terminology system on January 1, 1990. There have been no significant updates to the code since its addition.

9. Similar codes to CPT 74420

Five similar codes to CPT 74420 and how they differ are:

  • CPT 74400: Urography, intravenous, with or without KUB; this code is used for intravenous urography procedures, which involve injecting contrast material into a vein rather than directly into the ureter(s).
  • CPT 74410: Urography, antegrade, with or without KUB; this code is used for antegrade urography procedures, in which contrast material is injected into the renal pelvis through a percutaneous nephrostomy tube.
  • CPT 74415: Percutaneous nephrostogram and/or ureterogram, complete diagnostic procedure, including imaging supervision, interpretation, and report; this code is used for percutaneous nephrostogram and/or ureterogram procedures, which involve imaging the renal collecting system and ureter(s) through a percutaneous nephrostomy tube.
  • CPT 74425: Urography, cystography, minimum of 3 views; this code is used for cystography procedures, which involve imaging the bladder using contrast material.
  • CPT 74430: Cystourethrography, minimum of 3 views; this code is used for cystourethrography procedures, which involve imaging the bladder and urethra using contrast material.

10. Examples

  1. A patient with a history of recurrent urinary tract infections and hematuria undergoes a retrograde urography procedure to evaluate for possible upper urinary tract obstruction.
  2. A patient with known kidney stones experiences sudden onset flank pain and undergoes a retrograde urography procedure to assess for possible ureteral obstruction.
  3. A patient with a suspected ureteral stricture undergoes a retrograde urography procedure to confirm the diagnosis and determine the extent of the abnormality.
  4. A patient with a history of bladder cancer undergoes a retrograde urography procedure to evaluate for possible tumor recurrence or metastasis to the upper urinary tract.
  5. A patient with unexplained hydronephrosis on ultrasound undergoes a retrograde urography procedure to determine the cause of the kidney swelling.
  6. A patient with a history of multiple urinary tract surgeries undergoes a retrograde urography procedure to assess for possible postoperative complications or strictures.
  7. A patient with a known ureteropelvic junction obstruction undergoes a retrograde urography procedure to evaluate the severity of the obstruction and plan for surgical intervention.
  8. A patient with a suspected ureteral fistula undergoes a retrograde urography procedure to confirm the diagnosis and determine the location of the abnormal connection.
  9. A patient with a history of pelvic radiation therapy undergoes a retrograde urography procedure to assess for possible radiation-induced damage to the upper urinary tract.
  10. A patient with a suspected ureteral diverticulum undergoes a retrograde urography procedure to confirm the diagnosis and determine the size and location of the outpouching.

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