Bernadette10
Guru
I didn't think this was enough to bill 52330 since the note doesn't say anything about the stone being manipulated or moved, but the provider disagreed and said it's enough since the stone was large, and getting the wire past it was difficult and was manipulation. Can anyone confirm that an addendum should be added to bill 52330-LT? 52332-LT was also charged. Thanks for any reassurance.
Left side marked. KUB shows a very large stone in the left mid ureter and smaller stones in the lower pole calyx.
Bladder was entered with a 22 French scope. Bladder was notable for signs of cystitis cystica as well as some cystitis glandularis. Cone-tip catheter was used to take retrograde pyelogram that showed no distal ureteral pathology, but no dye would go beyond the stone.
Using a combination of a sensor wire and Pollick catheter we were able to pass a wire by the stone up to the kidney under fluoroscopic control. We could pass the Pollick over the wire into the kidney, but it was somewhat tight. Wire removed. There is a mild hydronephrotic drip. Retrograde contrast injection demonstrated significant hydronephrosis. Given the size of the stone, location of the stone and the fact that there are no other stones in the kidney to be dealt with, I thought the safer situation would be to place a large stent at this time to allow for soft dilation and return for a second stage.
Length was measured at 24 cm. Over the safety wire a 7 French by 24 cm double-J stent was then positioned in the left collecting system under fluoroscopic control. X-ray confirmed good position. The bladder was emptied and scope removed. Patient tolerated the procedure well.
Operative Findings: Large impacted left mid ureteral stone; left renal stones
Left side marked. KUB shows a very large stone in the left mid ureter and smaller stones in the lower pole calyx.
Bladder was entered with a 22 French scope. Bladder was notable for signs of cystitis cystica as well as some cystitis glandularis. Cone-tip catheter was used to take retrograde pyelogram that showed no distal ureteral pathology, but no dye would go beyond the stone.
Using a combination of a sensor wire and Pollick catheter we were able to pass a wire by the stone up to the kidney under fluoroscopic control. We could pass the Pollick over the wire into the kidney, but it was somewhat tight. Wire removed. There is a mild hydronephrotic drip. Retrograde contrast injection demonstrated significant hydronephrosis. Given the size of the stone, location of the stone and the fact that there are no other stones in the kidney to be dealt with, I thought the safer situation would be to place a large stent at this time to allow for soft dilation and return for a second stage.
Length was measured at 24 cm. Over the safety wire a 7 French by 24 cm double-J stent was then positioned in the left collecting system under fluoroscopic control. X-ray confirmed good position. The bladder was emptied and scope removed. Patient tolerated the procedure well.
Operative Findings: Large impacted left mid ureteral stone; left renal stones