Bilateral nephroureteral stent exchange


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Help me to code this report can we code this as 50387-50

The patient was placed on the angiography table in the prone
position. Both flanks including the external portions of the
nephroureteral stents were prepped and draped in the usual sterile
fashion. 1% lidocaine was administered for local anesthesia of the
skin and subcutaneous tissues. Preliminary scout film demonstrated
bilateral nephroureteral stents with pigtails formed in the
bilateral flanks and pelvis. Contrast was injected through the
nephroureteral stents demonstrating proper positioning.

Under fluoroscopic guidance an Amplatz wire was advanced through
the right stent and into the urinary bladder. The stent was
Over the Amplatz a new 8Fr 22cm long nephroureteral stent was
placed on the right with the distal pigtail within the bladder and
proximal pigtail within the renal pelvis. Proper position was
confirmed with injection of contrast
under fluoroscopic observation.

Under fluoroscopic guidance an Amplatz wire was advanced through
the left ureteral stent. During advancement the right ureteral
stent backout of the bladder. The Amplatz wire could not be
advanced further. The Amplatz wire was then removed. A Glidewire
was then advanced through the ureteral stent and advanced into the
distal ureter. The stent was removed. Attempt at advancing a
Berenstein catheter beyond the renal pelvis however were not
initially possible. The Glidewire was then retracted into the
renal pelvis and redirected into the ureter. This was then
successfully advanced into the bladder. The Berenstein catheter
was advanced over the Glidewire into the bladder. The Glidewire
was exchanged for an Amplatz wire. A new 8-French by 22-cm
nephroureteral stent was advanced over the Amplatz wire and
positioned with distal pigtail within the bladder and proximal
pigtail within the renal pelvis. The catheter was secured in
position. Position was confirmed with injection of dilute
contrast material. Once position of both catheters was confirmed
a sterile dressing was applied to the exit sites. The catheters
were connected to gravity bag drainage.. The patient tolerated the
well, no immediate complications.

Impression: Exchange of bilateral
nephroureteral stents with 8Fr 22cm stents placed bilaterally.


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I would do 50387-50 also.

50387: The physician removes and replaces an externally accessible transnephric ureteral stent under fluoroscopic guidance. A transnephric ureteral stent is one that is placed through the wall of the flank into the renal pelvis and down into the ureter to keep the ureter open. Contrast may be injected at the entry site to assess anatomy and positioning. The suture holding the pigtail in place is cut and a guidewire is threaded through the stent lumen until it exits the distal end. The original stent is removed over the guidewire. Diameter and length are noted for a new stent, which is threaded over the guidewire until the distal end forms within the bladder. Fluoroscopy is used to assess the proximal position of formation within the renal pelvis. After position is verified, the guidewire is removed and the suture is put in position to hold the pigtail in place. Contrast may be injected to check position and function. Final adjustments are made for patient comfort, and the catheter may be sutured to the skin, capped, or a drainage bag may be attached.


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I agree as well...CPT Assistant, Sept. 2006 page 4 has a clinical example which supports the use of this code; also CPT indicates that mod -50 is appropriate when performed bilaterally.