Jan314
Contributor
We began by deflating/deactivating the pt's AUS. We then introduced the 22F rigid cystoscope gently into the urethral meatus. The meatus was patent and there was no pathologic narrowing of the fossa navicularis. The pendulous and distal bulbar urethra appeared normal without any areas of narrowing. In the more proximal bulbar urethra, we came to the previously identified stricture. A retrograde urethrogram was performed as detailed below. A sensor wire was introduced through the scope and on into the bladder with its location confirmed on fluoroscopy.
One of my Urology doctors wants to bill 52276 for the below along with 0499T. Per note he did not use a cutting instrument but instead uses the balloon to create a tear. I don't feel that's the appropriate code.
At this time, an 18Fr Uromax urethral balloon was advanced over the wire through the scope until it was seen on direct vision to pass through the stricture. Under direct vision, this was inflated to the appropriate pressure and was seen to inflate appropriately and tear/incise through the stricture in a satisfactory circumferential way. At this time, we were satisfied that we had a nice urethral wound bed to which we could apply the paclitaxel medication. We then deflated the balloon and removed the balloon.
We then proceeded with more proximal cystourethroscopy using a 17Fr rigid cystoscope.
The membranous urethra appeared normal without obvious abnormalities. The prostate was surgically absent. There was some narrowing of the vesicourethral anastomosis as well but this did permit the 17 Fr scope with minor resistance.
The scope was then advanced into the bladder. The bladder wall appeared normal, without inflammation or trabeculation. There were no appreciable lesions within the bladder. No stones or significant debris apparent. Both ureteral orifices were identified to be in their orthotopic position.
One of my Urology doctors wants to bill 52276 for the below along with 0499T. Per note he did not use a cutting instrument but instead uses the balloon to create a tear. I don't feel that's the appropriate code.
At this time, an 18Fr Uromax urethral balloon was advanced over the wire through the scope until it was seen on direct vision to pass through the stricture. Under direct vision, this was inflated to the appropriate pressure and was seen to inflate appropriately and tear/incise through the stricture in a satisfactory circumferential way. At this time, we were satisfied that we had a nice urethral wound bed to which we could apply the paclitaxel medication. We then deflated the balloon and removed the balloon.
We then proceeded with more proximal cystourethroscopy using a 17Fr rigid cystoscope.
The membranous urethra appeared normal without obvious abnormalities. The prostate was surgically absent. There was some narrowing of the vesicourethral anastomosis as well but this did permit the 17 Fr scope with minor resistance.
The scope was then advanced into the bladder. The bladder wall appeared normal, without inflammation or trabeculation. There were no appreciable lesions within the bladder. No stones or significant debris apparent. Both ureteral orifices were identified to be in their orthotopic position.