Crystal's MCW Coder HubCPT Code 74420: Documentation & Billing Guide
🏥 74420: Retrograde Urography (S&I)
ICD-10-CM/CPT Code(s)
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74420 - Retrograde Urography (S&I): This code is used for the radiological supervision and interpretation (S&I) of a retrograde pyelogram. It involves the urologist or radiologist injecting contrast through a ureteral catheter (introduced via cystoscopy) to visualize the renal pelvis and ureters.
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BT14YZZ - Fluoroscopy of Kidneys, Ureters, and Bladder: (ICD-10-PCS) This is the procedural equivalent for inpatient hospital coding, representing fluoroscopic imaging using “other contrast” (non-ionic or ionic) for the urinary system.
CPT/HCPCS Code(s)
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74420 - Urography, retrograde, with or without KUB: This is an “S&I” code. It covers the physician’s work in supervising the imaging and interpreting the results.
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Use Case: Typically billed by the urologist when they perform the injection and interpretation in an ASC or hospital, or by a radiologist if they are providing the interpretation.
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Note: If the physician is only providing the interpretation, append Modifier -26.
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Global Periods
- XXX: This code is a diagnostic radiology service and does not have a global period. It is not subject to the 000, 010, or 090-day surgical follow-up rules.
HCC Information
- Direct Link: This procedure code does not directly map to an HCC (Hierarchical Condition Category) risk adjustment model. However, the diagnoses it often confirms (e.g., Renal Cell Carcinoma C64.1/C64.2) are major HCC drivers.
Exclusives/Inclusives
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Inclusives (Commonly Bundled Into): * This code is frequently bundled with more comprehensive surgical codes. For example, if a ureteral stent is placed (52332) or a stone is removed (52353), the 74420 is often considered incidental unless a separate diagnostic study was performed and documented prior to the therapeutic intervention.
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Mutually Exclusives: * 52005: Often performed with 52005 (Cystourethroscopy with ureteral catheterization). While they are often billed together, NCCI edits require that the retrograde pyelogram (74420) must be a “true diagnostic” study (documented findings and interpretation) to be separately payable with Modifier -59 or -XS.
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Assistant Surgeons: * Assistant Payable: No. Medicare and most commercial payers do not allow an assistant at surgery for this radiological S&I code.
Clinical Context & Use Cases
Retrograde pyelography is most commonly performed to identify the site of a urinary tract obstruction (like a stone or tumor) or to provide anatomical “road mapping” when the upper urinary tract cannot be adequately visualized via intravenous urogram (IVP) or CT urogram due to poor renal function or allergy.
Commonly Associated ICD-10-CM Diagnosis Codes: