This has been a week of cases unlike anything I have ever seen! I'm not 100% sold on where I'm going with this one, so any feedback would be appreciated!
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Pre/Post Op Diagnoses:
Retained suprapubic or Foley catheter in an Indiana pouch because of a large calculus which is calcified on the catheter within the pouch or calcified catheter within Indiana pouch.
Procedure: Open abdominal exploration of Indiana pouch with removal of calcified catheter and Indiana pouch stones with placement of silicone 14-French Foley catheter into the catheterizable stoma and closure of Indiana pouch and abdominal incision.
Findings: The patient was found to have a large smooth calcified stone on the catheter, which is grossly enlarged. Please see path for measurements. He also had multiple other stones within the bottom of the Indiana pouch, which were removed. The catheterizeable stoma is below this incision and it was able to be catheterized with a silicone 14-French Foley, and this is located within the entrance to the pouch on the right lateral aspect of the pouch. The Indiana pouch was completely cleaned out and closed without complicate. No safety valve or other catheter was left in place. The only drainage is through the 14-French silicone catheter.
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Now, I know that the Indiana pouch is the patient's recreated bladder and should be addressed as if it were the bladder. So I'm thinking of coding it the 51050 with the 51703 - which is permissible on AUA with appropriate modifier. Since it's technically in the stoma, I'm thinking it could fly. Does anyone else see anything differently?
Thanks in advance!
---
Pre/Post Op Diagnoses:
Retained suprapubic or Foley catheter in an Indiana pouch because of a large calculus which is calcified on the catheter within the pouch or calcified catheter within Indiana pouch.
Procedure: Open abdominal exploration of Indiana pouch with removal of calcified catheter and Indiana pouch stones with placement of silicone 14-French Foley catheter into the catheterizable stoma and closure of Indiana pouch and abdominal incision.
Findings: The patient was found to have a large smooth calcified stone on the catheter, which is grossly enlarged. Please see path for measurements. He also had multiple other stones within the bottom of the Indiana pouch, which were removed. The catheterizeable stoma is below this incision and it was able to be catheterized with a silicone 14-French Foley, and this is located within the entrance to the pouch on the right lateral aspect of the pouch. The Indiana pouch was completely cleaned out and closed without complicate. No safety valve or other catheter was left in place. The only drainage is through the 14-French silicone catheter.
---
Now, I know that the Indiana pouch is the patient's recreated bladder and should be addressed as if it were the bladder. So I'm thinking of coding it the 51050 with the 51703 - which is permissible on AUA with appropriate modifier. Since it's technically in the stoma, I'm thinking it could fly. Does anyone else see anything differently?
Thanks in advance!