toria11
Guru
Is there a way to bill for a difficult stent exchange? The provider had a difficult time removing the patient's encrusted stent, then replaced it. I'm aware you cannot bill 52315 with 52332. Would modifier -22 be appropriate in this case? Thanks!
PROCEDURES PERFORMED: 1. Left ESWL.
2. Left ureteral stent exchange, difficult
(6-French x 22 cm).
FINDINGS: Her left renal stone was clearly visualized for left ESWL. This appeared to be fully
fragmented based on intraoperative fluoroscopic imaging. She had mild to moderate amount of
encrustation around the distal end of the stent in the bladder. Her stent was able to be removed with
moderate resistance but intact. A double-J stent was placed in excellent position.
The patient was then carefully positioned in the modified dorsal lithotomy position. This was difficult to
flexion contractures especially on the right-hand side. After successful positioning, she was then prepped
and draped in usual sterile fashion for cystoscopy. The 22-French cystoscope sheath was passed with the
obturator in place. She had severely retracted urethral meatus. The scope was introduced with the
grasping forceps. Her bladder was deflected anteriorly likely due to chronic constipation and fecal
impaction. She had moderate to severe stent cystitis. Her stent was visualized emanating from the left
ureteral orifice with moderate encrustations around the distal coil. A hydrophilic guidewire was passed
through the angled tip catheter up into the renal pelvis. The catheter was then removed. The guidewire
was left in place. The scope was passed adjacent to the guidewire and using grasping forceps and gentle
traction, the stent was able to be removed. This took more than twice the usual length to accomplish due
to patient's body habitus, inflammation, and the stent encrustation. The guidewire was then backloaded
through the cystoscope once the stent was removed. A 6-French x 22 cm double-J stent was then placed
over the guidewire under fluoroscopic guidance and direct vision. The guidewire was removed and there
was an excellent curl in the renal pelvis as well as in the bladder. Bladder was emptied. She tolerated the
procedure well.
PROCEDURES PERFORMED: 1. Left ESWL.
2. Left ureteral stent exchange, difficult
(6-French x 22 cm).
FINDINGS: Her left renal stone was clearly visualized for left ESWL. This appeared to be fully
fragmented based on intraoperative fluoroscopic imaging. She had mild to moderate amount of
encrustation around the distal end of the stent in the bladder. Her stent was able to be removed with
moderate resistance but intact. A double-J stent was placed in excellent position.
The patient was then carefully positioned in the modified dorsal lithotomy position. This was difficult to
flexion contractures especially on the right-hand side. After successful positioning, she was then prepped
and draped in usual sterile fashion for cystoscopy. The 22-French cystoscope sheath was passed with the
obturator in place. She had severely retracted urethral meatus. The scope was introduced with the
grasping forceps. Her bladder was deflected anteriorly likely due to chronic constipation and fecal
impaction. She had moderate to severe stent cystitis. Her stent was visualized emanating from the left
ureteral orifice with moderate encrustations around the distal coil. A hydrophilic guidewire was passed
through the angled tip catheter up into the renal pelvis. The catheter was then removed. The guidewire
was left in place. The scope was passed adjacent to the guidewire and using grasping forceps and gentle
traction, the stent was able to be removed. This took more than twice the usual length to accomplish due
to patient's body habitus, inflammation, and the stent encrustation. The guidewire was then backloaded
through the cystoscope once the stent was removed. A 6-French x 22 cm double-J stent was then placed
over the guidewire under fluoroscopic guidance and direct vision. The guidewire was removed and there
was an excellent curl in the renal pelvis as well as in the bladder. Bladder was emptied. She tolerated the
procedure well.