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Bladder Neck Contracture Dilation / attempted contracture incision

rgeib

Networker
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37
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Looking for some advice on the following:

PREOPERATIVE DIAGNOSIS: Bladder neck contracture.

POSTOPERATIVE DIAGNOSIS: Bladder neck contracture.

OPERATION: Cystoscopy, bladder neck dilation, Foley placement,
attempted bladder neck incision.


INDICATIONS FOR SURGERY:
The patient has a history of TURP in the past with bladder neck contracture and hematuria. The patient also has obstructive urinary symptoms, comes in for bladder neck incision,
ended up with dilation,
see below.

DESCRIPTION OF OPERATION:
The patient was identified in the waiting room and brought into the
OR. Preoperative antibiotics were provided. Anesthesia was
administered. The patient was placed in lithotomy position, then
prepped and draped in a standard sterile surgical fashion. Time-out
was performed. Consent was verified. Next, a 19-French cystoscope
with a 30-degree lens was inserted into the urethra. No strictures
in the anterior urethra. Prostatic fossa appeared open. The
bladder neck was very tight and contracted. I could not easily pass
the scope. Next, a Sensor wire was passed through the scope into
the bladder. The scope was removed. Next, I decided to dilate the
bladder neck a little bit so I can pass the urethra tome with the
Collins knife using blue plastic dilators. I slowly dilated the
bladder neck from size 18 to size 24, which was the biggest dilator
I had. The Collins knife was only available to use with the
26-French sheath and obturator. I removed the wire and slowly tried
to pass the 26 sheath with an internal obturator. I did meet some
resistance at the bladder neck. I then stopped. Inserted a camera.
I could see the bladder neck opening, but also the patient appeared
to have a false passage to the right side at the level of the
prostate. I then decided to just leave a Foley catheter.
Again, I
placed a 19-French scope, passed a wire into the bladder. I again
passed a dilator. The 24-French dilator passed easily into the
bladder without resistance. A 22-French Council tip Foley catheter
was then passed over the wire into the bladder. Balloon inflated
with 15 mL of sterile water. Urine output was clear. No hematuria
was noted. The patient tolerated the procedure well, was sent to
recovery room in stable condition.

At first, I was planning to just bill 52281 for the contracture dilation, but since the intent was to initially do the incision, would it be more appropriate to bill as 52276-52? I have read articles from the AUA's Michael Ferragamo stating 52276 is appropriate for contracture incisions secondary to prostatectomies. Any help would be appreciated. Thanks in advance.
 
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