drainage

[prabha]

This should be coded as 49021 & 75989 or 50390 & 76942.

84 year old male with large left renal cyst resulting in
significant abdominal distension (difficulty with wearing clothes)
referred for percutaneous drainage.

Indication: abdominal distension

Procedure:
With the patient in the supine position the left mid abdomen was
prepped and draped in the usual sterile fashion. Ultrasound
examination demonstrates a well-circumscribed fluid collection
correlating well with the findings on CT.There is a smooth margins
to the cyst wall. Multiple, thin sepations are present in the
more dependent portions of the cyst.
After administration of local anesthesia, access was obtained
into the fluid cavity using an 18 gauge needle under real time
ultrasound guidance. Several cc's of chocolate colored fluid were
aspirated and sent for microbiology and chemistry. Exchange was
made for serial dilators under fluoroscopic guidance after which
an 8 French pigtail drainage catheter was placed successfully in
the cavity using fluoroscopic guidance. Approximately 2700 cc's
of fluid were aspirated.

Subsequently 30 cc of anhydrous absolute alcohol was instilled
into the cyst cavity. The catheter was capped. The patient was
placed in different positions on the stretcher to insure coating
of the lining of the cyst with the sclerosing agent. After 25
minutes, residual alcohol was aspirated and the catheter was
removed. The patient tolerated the procedure without incident.

Conclusion:
Real time ultrasound-guided access of a large left renal cyst.

Multiple internal septations within the cyst cavity are
demonstrated on ultrasound exam. No definitive mural nodules are
identified.

Ultrasound guided aspiration and drainage of a large left renal
cyst with drainage of 2700 cc of chocolate colored fluid.

Sclerosis of large left renal cyst using anhydrous absolute
ethanol as described above.

[drspatil]

CPT codes should be 50390 & 76942.

[Jim Pawloski]

Originally Posted by prabha

This should be coded as 49021 & 75989 or 50390 & 76942.

84 year old male with large left renal cyst resulting in
significant abdominal distension (difficulty with wearing clothes)
referred for percutaneous drainage.

Indication: abdominal distension

Procedure:
With the patient in the supine position the left mid abdomen was
prepped and draped in the usual sterile fashion. Ultrasound
examination demonstrates a well-circumscribed fluid collection
correlating well with the findings on CT.There is a smooth margins
to the cyst wall. Multiple, thin sepations are present in the
more dependent portions of the cyst.
After administration of local anesthesia, access was obtained
into the fluid cavity using an 18 gauge needle under real time
ultrasound guidance. Several cc's of chocolate colored fluid were
aspirated and sent for microbiology and chemistry. Exchange was
made for serial dilators under fluoroscopic guidance after which
an 8 French pigtail drainage catheter was placed successfully in
the cavity using fluoroscopic guidance. Approximately 2700 cc's
of fluid were aspirated.

Subsequently 30 cc of anhydrous absolute alcohol was instilled
into the cyst cavity. The catheter was capped. The patient was
placed in different positions on the stretcher to insure coating
of the lining of the cyst with the sclerosing agent. After 25
minutes, residual alcohol was aspirated and the catheter was
removed. The patient tolerated the procedure without incident.

Conclusion:
Real time ultrasound-guided access of a large left renal cyst.

Multiple internal septations within the cyst cavity are
demonstrated on ultrasound exam. No definitive mural nodules are
identified.

Ultrasound guided aspiration and drainage of a large left renal
cyst with drainage of 2700 cc of chocolate colored fluid.

Sclerosis of large left renal cyst using anhydrous absolute
ethanol as described above.

I agree with 50390 and 76942, but for the sclerosing procedure, I think you can use the unlisted procedure code, with using the biliary sclerosing charge 47399 as the basis for the cost of procedure.

Thanks,
Jim

[MLS2]

renal cyst sclerose-53899