Exchange Neph to Nephroureteral cath with ureteral dilatation

Liza559

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Coding help with this one.

Clinical Indication: GU tract malignancy. Obstruction. Pt. has nephrostomy catheters which have been very problematic, frequently becoming dislodged. Request is made to attempt internalization.Considering the situation and the future need for transurethral exchange and the uncertainty as to whether or not the patient can tolerate antegrade drainage, I elected to place bilateral nephroureteral stents rather than a seperate ureteral stent.

Procedure and Findings:
1. Bilateral antegrade nephrostogram
2. Bilateral ureteral angioplasty with nephroureteral stent placement

Patient placed prone. Left nephrostomy was addressed first. there is decompression although occlusion at the level of the sacral promontory. This was crossed without much difficulty using a 5 fr. catheter and glidewire. However, a 10 fr. nephroureteral catheter would not pass. Therefore, balloon dilatation was undertaken with a 6mm wide and 4cm long balloon at which point the catheteer was inserted over an amplatz guidewire and appropriately positioned with the securing loop in the bladder and the proximal loop in the renal pelvis.

Right side was then addressed. There was a high-grade stricture distally. Over a stiff shaft glidewire and a long 8 french arrow sheath, the occlusion was evetually traversed. The 6mm balloon catheter was used to dilate the stricture and second 10fr x 26cm long nephroureteral stent was placed.

At this point, contrast was injected showing rapid flow to the bladder. Catheters were capped and patient returned to floor.

checking to see if appropriate to code 53899-50;74485-50;50387-50?
 

Jim Pawloski

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Coding help with this one.

Clinical Indication: GU tract malignancy. Obstruction. Pt. has nephrostomy catheters which have been very problematic, frequently becoming dislodged. Request is made to attempt internalization.Considering the situation and the future need for transurethral exchange and the uncertainty as to whether or not the patient can tolerate antegrade drainage, I elected to place bilateral nephroureteral stents rather than a seperate ureteral stent.

Procedure and Findings:
1. Bilateral antegrade nephrostogram
2. Bilateral ureteral angioplasty with nephroureteral stent placement

Patient placed prone. Left nephrostomy was addressed first. there is decompression although occlusion at the level of the sacral promontory. This was crossed without much difficulty using a 5 fr. catheter and glidewire. However, a 10 fr. nephroureteral catheter would not pass. Therefore, balloon dilatation was undertaken with a 6mm wide and 4cm long balloon at which point the catheteer was inserted over an amplatz guidewire and appropriately positioned with the securing loop in the bladder and the proximal loop in the renal pelvis.

Right side was then addressed. There was a high-grade stricture distally. Over a stiff shaft glidewire and a long 8 french arrow sheath, the occlusion was evetually traversed. The 6mm balloon catheter was used to dilate the stricture and second 10fr x 26cm long nephroureteral stent was placed.

At this point, contrast was injected showing rapid flow to the bladder. Catheters were capped and patient returned to floor.

checking to see if appropriate to code 53899-50;74485-50;50387-50?
I would use 50393-50, 74425-50 for the nephrostograms, and 50394-50 and 74480-50 for the nephrouretural stent placements (these are considered uretural stent placements),and 53899-50 and 74485-50 for the uretural angioplasty.
HTH,
Jim Pawloski, CIRCC
 

donnajrichmond

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I would use 50393-50, 74425-50 for the nephrostograms, and 50394-50 and 74480-50 for the nephrouretural stent placements (these are considered uretural stent placements),and 53899-50 and 74485-50 for the uretural angioplasty.
HTH,
Jim Pawloski, CIRCC
Jim, do you have your codes backwards?
50393 is ureteral stent placement and 50394 is nephrostogram.

Donna
 
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