Question Is Kidney Flushing Considered Manipulation?

toria11

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Just curious if flushing the kidney is considered manipulation as described in 52352 or if my only choice here is 52351 along with 52332. Thank you!!

POSTOPERATIVE DIAGNOSES: 1. Bilateral nonobstructing renal stones.
2. History of UTI.
3. Status post renal transplant.
ANESTHESIA: General.
INDICATIONS FOR PROCEDURE: The patient with a
history of end-stage renal disease with a renal transplant who has been having recurrent UTIs. Workup
which included CT stone protocol as well as cystoscopy showed bilateral nonobstructing stones.
Treatment options were discussed and she elected to proceed with definitive treatment of stones. We
decided to start on the left side as per CT, it appeared that the stones are big on the left side. After risks,
benefits and alternatives were explained to the patient, the patient elected to proceed and informed
consent was obtained.
DETAILS OF PROCEDURE: The patient was properly identified and brought back to the cystoscopy
room where she was laid supine on the cystoscopy table. A proper time-out was performed. Under the
direction of Anesthesiology, the patient was intubated and induced under general anesthetic. Ancef 1 g IV
was given within one hour to the start of the procedure. The patient was placed in the dorsal lithotomy
position and prepped and draped in a normal sterile surgical fashion. A rigid cystoscopy was carefully
passed into the patient’s bladder per urethra without any difficulty. The bladder was then drained. It was
gently filled. She had already had an office cystoscopy, therefore I was able to locate the native left
ureteral orifice, which appeared to be very tight in nature. With guidance of cystoscopy, I was able to
pass the wire all the way up into the left kidney. Using access sheath, I then was able to dilate the left
ureteral orifice and passed all the way up to the UPJ. Both wire and inner sheath was removed. I then
advanced the flexible ureteroscopy all the way up into the kidney. Her kidney was carefully examined.
There was no evidence of any tumors or bleeding in her kidney itself. Per CT, the stone appeared to be in
her lower pole for left kidney. I maneuvered into her cylix of the lower pole. There was a group of tiny
smaller stones fragments which may have been the corresponding findings on the CT scan. I attempted to
basket using the ZeroTip basket, but the fragments were so smaller that I could not basket them.
However, I did attempt to flush them out into the renal pelvis and hopefully they were passed on their
own. At this point, no other residual visible stones were seen or needed to be treated at this time. I then
passed the wire under direct visualization to the ureteroscopy up into the renal left kidney. This was
confirmed by fluoroscopy. I removed the ureteroscopy in the access sheath. I then passed a stent over
the wire up into the left kidney with a good possible curl in the left renal pelvis and a good curl in the
bladder. The string was then attached to her inner thigh and secured. This concluded the procedure. The
patient was extubated and sent to the recovery room in stable condition. She will be discharged home with
pain meds and antibiotics.
 
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