klen
Contributor
Hi Coders,
Here is my OP report:
"The right ureteral orifice was in their orthotopic location and was cannulated with a guidewire. A second wire was placed in the left ureteral orifice under fluoroscopic guidance with the help of ureteral dilator sheath and I then dilated left-sided ureteral stricture with a #14 French ureteral access sheath, first pass without difficulty with a #14 French ureteral access sheath under fluoroscopic guidance.
Mid-ureteroscopy and pyeloscopy was performed with the digital ureteroscope which showed excellent visualization of all structures. This revealed an approximately 1 cm left proximal ureteral mass that was papillary and concerning for ureteral cancer based on visual appearance.
There were no other tumors in the left kidney or calyces and I used the Piranha biopsy forceps to gain multiple biopsies of the ureteral mass and sent it for surgical pathology. I then placed a 365 nanometer Holmium laser fiber and proceeded to ablate the tumor in its entirety. This involved the ablating the base of the tumor which was somewhat broad taking care to not perforate the ureter or cause any undue damage to the underlying mucosa. I was able to completely remove the ureteral tumor in this fascia without causing significant bleeding. Again pyeloscopy after the resection showed intact mucosal surfaces and retrograde pyelogram imaging was performed which showed to extravasation of the contrast and no filling defects. A 6 French x2 cm ureteral stent was then placed with good curl of the stent in the renal pelvis as well as the bladder.
The bladder was then emptied and the cystoscope was removed after ureteral stent had been placed. The patient was returned to the supine position and awakened from anesthesia without complication.
The physician coded:
52355
52332
52341-59
74420-26
76000-26-59
United Healthcare is denying code 52341-59 as bundled with 52355, even with the -59 modifier, but I'm not sure why. Encoder indicates this would be appropriate billing with the modifier. What am I missing?
Thanks for any input.
Here is my OP report:
"The right ureteral orifice was in their orthotopic location and was cannulated with a guidewire. A second wire was placed in the left ureteral orifice under fluoroscopic guidance with the help of ureteral dilator sheath and I then dilated left-sided ureteral stricture with a #14 French ureteral access sheath, first pass without difficulty with a #14 French ureteral access sheath under fluoroscopic guidance.
Mid-ureteroscopy and pyeloscopy was performed with the digital ureteroscope which showed excellent visualization of all structures. This revealed an approximately 1 cm left proximal ureteral mass that was papillary and concerning for ureteral cancer based on visual appearance.
There were no other tumors in the left kidney or calyces and I used the Piranha biopsy forceps to gain multiple biopsies of the ureteral mass and sent it for surgical pathology. I then placed a 365 nanometer Holmium laser fiber and proceeded to ablate the tumor in its entirety. This involved the ablating the base of the tumor which was somewhat broad taking care to not perforate the ureter or cause any undue damage to the underlying mucosa. I was able to completely remove the ureteral tumor in this fascia without causing significant bleeding. Again pyeloscopy after the resection showed intact mucosal surfaces and retrograde pyelogram imaging was performed which showed to extravasation of the contrast and no filling defects. A 6 French x2 cm ureteral stent was then placed with good curl of the stent in the renal pelvis as well as the bladder.
The bladder was then emptied and the cystoscope was removed after ureteral stent had been placed. The patient was returned to the supine position and awakened from anesthesia without complication.
The physician coded:
52355
52332
52341-59
74420-26
76000-26-59
United Healthcare is denying code 52341-59 as bundled with 52355, even with the -59 modifier, but I'm not sure why. Encoder indicates this would be appropriate billing with the modifier. What am I missing?
Thanks for any input.