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Old 10-28-2013, 12:37 PM
margaret fahy margaret fahy is offline
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Default POUCHOGRAM/rETROGRADE INTO COLONIC POUCH

Guys,
Not really an IR, but do you code these, or if you did, which procedure code would you use?
Thanks.
Margie

Indications:

Reason:21 year old girl with history of small neurogenic bladder s/p creation of transverse colon conduit with stomal pain, please evaluate conduit



Interpretation: Pouchogram
History.21-year-old with history of small neurogenic bladder,
post transverse colon conduit, stones seen in the right ureter
is CT scan October 09, 2013
Technique retrograde contrast water-soluble contrast into the
colonic pouch following placement of the Foley catheter placement
of 5 cc air in ballon in the opening, of conduit

Finding plain radiograph of the abdomen prior to the study shows
absence of sacrum and coccyx. Surgical clips is seen in the right
side of the pelvis, ostomy seen on the left side overlying the
left iliac bone.
No filling defect is seen within conduit pouch, no extravasation
of the contrast seen through the conduit. Initially reflux
occurred to the left mildly dilated and tortuous ureter up to the
collecting system which is moderately dilated, later reflux
occurred into right ureter reaching the right collecting system
without obstruction collecting system of the right kidney is
mildly dilated following removal of the Foley catheter the pouch
is completely drained, residual contrast is seen within the
tortuous left ureter and dilated . left collecting system, and
collecting system of the right kidney.

IMPRESSION
Colonic conduit demonstrate with no evidence of
extravasation or obstruction, reflux of contrast seen first to
the left ureter and collecting system followed to the right
ureter and collecting system without obstruction.
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  #2  
Old 10-31-2013, 06:28 AM
margaret fahy margaret fahy is offline
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Default Retrograde into Colonic Pouch

Hey Guys,
Can someone give me an opinion on this?
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  #3  
Old 10-31-2013, 08:41 AM
dpeoples dpeoples is offline
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Default

Quote:
Originally Posted by margaret fahy View Post
Guys,
Not really an IR, but do you code these, or if you did, which procedure code would you use?
Thanks.
Margie

Indications:

Reason:21 year old girl with history of small neurogenic bladder s/p creation of transverse colon conduit with stomal pain, please evaluate conduit



Interpretation: Pouchogram
History.21-year-old with history of small neurogenic bladder,
post transverse colon conduit, stones seen in the right ureter
is CT scan October 09, 2013
Technique retrograde contrast water-soluble contrast into the
colonic pouch following placement of the Foley catheter placement
of 5 cc air in ballon in the opening, of conduit

Finding plain radiograph of the abdomen prior to the study shows
absence of sacrum and coccyx. Surgical clips is seen in the right
side of the pelvis, ostomy seen on the left side overlying the
left iliac bone.
No filling defect is seen within conduit pouch, no extravasation
of the contrast seen through the conduit. Initially reflux
occurred to the left mildly dilated and tortuous ureter up to the
collecting system which is moderately dilated, later reflux
occurred into right ureter reaching the right collecting system
without obstruction collecting system of the right kidney is
mildly dilated following removal of the Foley catheter the pouch
is completely drained, residual contrast is seen within the
tortuous left ureter and dilated . left collecting system, and
collecting system of the right kidney.

IMPRESSION
Colonic conduit demonstrate with no evidence of
extravasation or obstruction, reflux of contrast seen first to
the left ureter and collecting system followed to the right
ureter and collecting system without obstruction.
This is kinda tricky, it is not a colon pouchogram, it is an injection of an ileal conduit made for urinary diversion. I would code this 50690/74425.

HTH
__________________
Danny L. Peoples
CIRCC,CPC
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  #4  
Old 10-31-2013, 10:16 AM
margaret fahy margaret fahy is offline
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Default Pouchogram/ileal conduit

Dear True...
I see...you are absolutely right. we get a code that comes thru. this one came thru with 49465, so i wasn't going to bill that, and it wasn't a fistulogram...was not sure...going to make a notation in my book...cool.
Thanks so much, and have a peaceful weekend.
Margie
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