suela923@aol.com
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This dictation is really scattered but I thought I could bill 50394,74425, 50393, 74480. I wanted to bill 50394 for the statement starting with " A 0.018 guidewire was coiled in the renal pelvis...The catheter was injected showing complete occulsion of the left distal ureter.....
Would you bill a nephrostogram for the statement at the end of the paragraph....An initial nephrostogram was performed showing moderate left-sided hydronephrosis and hydrourether? (I am not thinking of billing it twice, just trying to decide if I can bill it once) I would expect to see this at the beginning of the dictation, not at the end. Plus the doctor's heading stated it after the stent placement. Like I said this was a really scattered dictation!
thanks! Sue
Percutaneous placement of left nephroureteral stent, and left nephroureterogram under ultrasound and fluoroscopic guidance on 11/4/13.
Clinical indication: Endometrial carcinoma with left-sided hydronephrosis. Status post pelvic exenteration. Status post radiation therapy.
Informed consent was obtained. The patient was prepped and draped in the usual sterile fashion. The skin was anesthetized with 1% Xylocaine. Under ultrasound guidance an AccuStick needle was placed into a left lower pole posterior calyx. Hard copy documentation of the ultrasound was obtained. A 0.018 guidewire was coiled in the renal pelvis. The AccuStick introducer was placed. A 0.035 guidewire was then advanced down the left ureter. Over the guidewire a 5-French Kumpe catheter was placed. The catheter was injected showing complete occlusion of the left distal ureter in the right side of the pelvis at the level of the midportion of the SI joint. Multiple surgical clips are noted in the pelvis. The obstruction was probed with multiple guidewires. One of the guidewires extended beyond the level of obstruction. This was injected outlining irregularly marginated extraluminal contrast collections which appear to communicate with the peroneal region. As the obstruction could not be crossed with a guidewire it was elected to place a nephroureteral catheter with removal of the distal pigtail. A peel-away sheath was placed. Through the peel-away sheath an 8.5-French nephroureteral catheter was placed with 10 cm cut off of the distal end. The proximal pigtail was in the renal pelvis and the ureteral catheter extended to just above the level of the obstruction. An initial nephrostogram was performed showing moderate left-sided hydronephrosis and hydroureter. Following drainage of the pyelocaliectasis and hydroureter was improved significantly.
Result Impression
Complete obstruction of the left distal ureter in the right side of the pelvis.
Multiple attempts were made to cross the obstruction with a variety of guidewires. One of the guidewires extended beyond the obstruction and injection showed extravasation into the pelvic soft tissues with extension to the peroneal region through a fistulous tract.
The patient will be scheduled to return in approximately one weeks' time in an attempt to cross the high-grade distal ureteral obstruction. If this is unsuccessful she will need continued external drainage.
Would you bill a nephrostogram for the statement at the end of the paragraph....An initial nephrostogram was performed showing moderate left-sided hydronephrosis and hydrourether? (I am not thinking of billing it twice, just trying to decide if I can bill it once) I would expect to see this at the beginning of the dictation, not at the end. Plus the doctor's heading stated it after the stent placement. Like I said this was a really scattered dictation!
thanks! Sue
Percutaneous placement of left nephroureteral stent, and left nephroureterogram under ultrasound and fluoroscopic guidance on 11/4/13.
Clinical indication: Endometrial carcinoma with left-sided hydronephrosis. Status post pelvic exenteration. Status post radiation therapy.
Informed consent was obtained. The patient was prepped and draped in the usual sterile fashion. The skin was anesthetized with 1% Xylocaine. Under ultrasound guidance an AccuStick needle was placed into a left lower pole posterior calyx. Hard copy documentation of the ultrasound was obtained. A 0.018 guidewire was coiled in the renal pelvis. The AccuStick introducer was placed. A 0.035 guidewire was then advanced down the left ureter. Over the guidewire a 5-French Kumpe catheter was placed. The catheter was injected showing complete occlusion of the left distal ureter in the right side of the pelvis at the level of the midportion of the SI joint. Multiple surgical clips are noted in the pelvis. The obstruction was probed with multiple guidewires. One of the guidewires extended beyond the level of obstruction. This was injected outlining irregularly marginated extraluminal contrast collections which appear to communicate with the peroneal region. As the obstruction could not be crossed with a guidewire it was elected to place a nephroureteral catheter with removal of the distal pigtail. A peel-away sheath was placed. Through the peel-away sheath an 8.5-French nephroureteral catheter was placed with 10 cm cut off of the distal end. The proximal pigtail was in the renal pelvis and the ureteral catheter extended to just above the level of the obstruction. An initial nephrostogram was performed showing moderate left-sided hydronephrosis and hydroureter. Following drainage of the pyelocaliectasis and hydroureter was improved significantly.
Result Impression
Complete obstruction of the left distal ureter in the right side of the pelvis.
Multiple attempts were made to cross the obstruction with a variety of guidewires. One of the guidewires extended beyond the obstruction and injection showed extravasation into the pelvic soft tissues with extension to the peroneal region through a fistulous tract.
The patient will be scheduled to return in approximately one weeks' time in an attempt to cross the high-grade distal ureteral obstruction. If this is unsuccessful she will need continued external drainage.