Question Laser Ablation of Ureteral Tumor?

toria11

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The first code that comes to mind is 52354 but the notes says this was an ablation, not fulguration. Thanks for your help!

POSTOPERATIVE DIAGNOSIS:
Left intramural ureter tumor.
PROCEDURE PERFORMED:
Cystoscopy, left ureteroscopy, left thulium laser ablation of ureteral tumor, left retrograde pyelogram, left double-J ureteral stent placement.
ANESTHESIA:
General.
INDICATIONS:
The 92-year-old gentleman low-grade TCC in the left ureteral orifice recently resected, but still concerned about residual tumor in the intramural ureter. Case was complicated by a partially duplicated system.

DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room after general anesthesia was instituted by the anesthesiologist. The patient was put in dorsal lithotomy position and prepped and draped in usual sterile fashion.

Using a 21-French cystoscope sheath, the bladder was entered via the urethra. The stent was grasped with grasping forceps, brought to the urethral meatus. An UltraTrack wire was advanced through the stent to the level of the upper pole collecting system. Using a Wolf semi-rigid ureteroscope, the left ureteral orifice was intubated. In the intramural ureter, there was some tumor. This was ablated with a 200 micron fiber at ablative settings. Please see the laser sheet for further details. After this was completed, the ureteroscope was removed. The cystoscope sheath was backed over the wire. A retrograde pyelogram was shot, which showed the duplicated system, which happens above the intramural ureter and the bifurcation is above where we ablated. The wire was placed in the upper pole collecting system. The cystoscope sheath was removed. The cystoscope sheath was backed over the wire and a 7 x 26 cm double-J stent was advanced. After a nice curl was seen in the upper pole collecting system, wire was removed. A nice curl was seen in the bladder.

Cystoscope sheath removed. The bladder was drained with red rubber catheter and the patient was then taken down out of dorsal lithotomy position, extubated and taken to the Recovery Room in stable condition. It should be noted that we did fluoro after the bladder was drained to make sure that both the upper and lower pole systems were draining.
 
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