Wiki Can Nephostogram be billed?

Create Wiki
S

suela923@aol.com

Guest
Messages
178
Best answers
0
I am being told to bill for the nephrostogram as well as the ureteral stent change but I feel this was a routine change and we should not bill for the nephrostogram even though it's dictated in a separate paragraph. Any thoughts on this? Thank you.

Exchange of left ureteral stent

History: A 45-year-old female with history of cervical cancer status post pelvic exoneration. She has an indwelling left ureteral stent which comes down into an ileostomy bag. She returns today for routine tube exchange.

Timeout procedure was performed. She was prepped and draped in the usual sterile fashion. Contrast was injected through the ureteral catheter and a nephrostogram was performed. The nephrostogram demonstrated mild left hydronephrosis. Left ureter was not opacified. There was some debris in the renal pelvis.

Previously placed ureteral stent was removed over a guidewire. A new 8.5-French 60 cm in length multipurpose tube was advanced over a guidewire through the ileostomy site up to the level of the left renal pelvis where it was coiled. Contrast was again injected through the tube and demonstrated excellent position of the catheter. There was some mild hydronephrosis.
 
In my opinion no.

This is from the NCCI manual:

CPT code 50398 describes change of a nephrostomy or pyelostomy tube. If the tube change occurs in a patient without new symptoms related to the tube, CPT code 50394 (injection procedure for pyelography through a nephrostomy or pyelostomy tube) should not be reported separately for the tube check. However, if the patient has new symptoms related to the tube, the provider may separately report CPT code 50394 with an NCCI-associated modifier for the tube check.
 
suela923@aol.com said:
I am being told to bill for the nephrostogram as well as the ureteral stent change but I feel this was a routine change and we should not bill for the nephrostogram even though it's dictated in a separate paragraph. Any thoughts on this? Thank you.

Exchange of left ureteral stent

History: A 45-year-old female with history of cervical cancer status post pelvic exoneration. She has an indwelling left ureteral stent which comes down into an ileostomy bag. She returns today for routine tube exchange.

Timeout procedure was performed. She was prepped and draped in the usual sterile fashion. Contrast was injected through the ureteral catheter and a nephrostogram was performed. The nephrostogram demonstrated mild left hydronephrosis. Left ureter was not opacified. There was some debris in the renal pelvis.

Previously placed ureteral stent was removed over a guidewire. A new 8.5-French 60 cm in length multipurpose tube was advanced over a guidewire through the ileostomy site up to the level of the left renal pelvis where it was coiled. Contrast was again injected through the tube and demonstrated excellent position of the catheter. There was some mild hydronephrosis.
Click to expand...

I would not code for a diagnostic nephrostogram, despite the interpretation. The reason is that we do not know if the condition of hydronephrosis was known or not. It is likely it was a known condition. Also, the indication in the "history" was that this was a "routine tube exchange", not a workup for a new sign or symptom. Medical necessity is established prior to a test, not based on the findings of a test.

HTH :)
 
Would you still bill 74425 for supervision and interpretation even if you don't bill the surgical code 50394 for the nephrostogram??

thanks!
 
You must log in or register to reply here.
Top