Wiki How would you code this?

[Aliciawashere]

An 035 Glidewire advantage wire was advanced through the indwelling left percutaneous nephrostomy tube. The catheter was removed over the wire. The wire and a glide catheter were used to navigate the left ureter and ileal conduit. Contrast injection revealed a widely patent ureter and ileal conduit. Once the catheter tip was maneuvered to the stoma, contrast was again injected revealing a tract the target. A Glidewire advantage and glide catheter were used to traverse the stoma. In this way, through and through access was obtained. An 8 French sheath was advanced through the stoma over the wire. The wire and catheter were retracted into the ileal conduit. Two Amplatz wires were advanced through the sheath into the ileal conduit. The sheath was removed. A 16 French pigtail catheter was advanced over one Amplatz wire. A 14 French pigtail catheter was advanced over the other Amplatz wire. A permanent image was stored. The catheter hubs were secured together with the suture knot. The

ostomy bag was reattached containing the catheter hubs.

A new 10 French nephrostomy catheter was advanced over the Glidewire advantage into the left renal pelvis. Contrast injection demonstrated the new catheter to be in good position. A permanent image was stored. The nephrostomy catheter was secured with a Molnar disc. The patient tolerated the procedure well. There were no immediate complications.

We have looked at this many ways. Ultimately we are leaning towards 53899 and 50435. Please let me know if you have different thoughts on code selection. TIA!

 

[whatwouldyousay]

We would assign 50693 since first access is antegrade via the existing nephrostomy and a neph tube placed at the end of the procedure is included with that code, when performed.