Here is the operative report. I thought it should be coded CPT 52356 RT since ESWL CPT 50590 failed to break the stone. The physician thinks it should be coded 50590 RT and 52332 RT. Any reference would be appreciated.
POSTOPERATIVE DIAGNOSIS: Right renal stone.
Pt was taken back to the OR, placed under anesthesia, moved to the lithotripsy table in the lithotomy position. Pt was coupled to the Lithotripter. After a time-out, I started shocking the stone at 1.5 shocks per second. I slowly increased the energy to a level of 6. I gave a total of 2500 shocks. The stone unfortunately did not appear to be breaking up very
well, so I proceeded with ureteroscopy. I passed the scope into the bladder. The urethra and bladder were normal. I passed a Sensor wire up the right ureter. I then passed a navigator access sheath, it went up easily. I was able to use a flexible scope. I saw the stone was in the mid to upper pole calyx. It actually had broken up some, but there was still a large piece that had to break more using a 200 micron holmium laser fiber. I then spent a lot of time basketing the pieces. There were multiple small pieces. When I was done, everything appeared to be 1 or 2 mm or smaller. I injected some contrast to outline the renal pelvis. I did not see any other large fragments. I then replaced a wire and I passed a 4.8 x 26 cm double-J stent.
The strings were removed. The bladder was drained. That was the end of the case.
POSTOPERATIVE DIAGNOSIS: Right renal stone.
Pt was taken back to the OR, placed under anesthesia, moved to the lithotripsy table in the lithotomy position. Pt was coupled to the Lithotripter. After a time-out, I started shocking the stone at 1.5 shocks per second. I slowly increased the energy to a level of 6. I gave a total of 2500 shocks. The stone unfortunately did not appear to be breaking up very
well, so I proceeded with ureteroscopy. I passed the scope into the bladder. The urethra and bladder were normal. I passed a Sensor wire up the right ureter. I then passed a navigator access sheath, it went up easily. I was able to use a flexible scope. I saw the stone was in the mid to upper pole calyx. It actually had broken up some, but there was still a large piece that had to break more using a 200 micron holmium laser fiber. I then spent a lot of time basketing the pieces. There were multiple small pieces. When I was done, everything appeared to be 1 or 2 mm or smaller. I injected some contrast to outline the renal pelvis. I did not see any other large fragments. I then replaced a wire and I passed a 4.8 x 26 cm double-J stent.
The strings were removed. The bladder was drained. That was the end of the case.