tlm5506
Networker
Hello.
Hoping I can get help with this procedure. Here is the op note dictation:
The 25 French cystoscope was passed under camera vision. No anterior urethral abnormalities were identified. There was mild prosthetic regrowth. There was now wide core vesical neck contracture. The urinary bladder was entered. The right and left ureteral orifices were in normal position. There is a large brown bladder calculus measuring approximately 2cm. There is a bladder diverticulum lateral to the ureteral orifice with a large papillary bladder tumor which coated the lining of this diverticulum. No other bladder tumors were identified. Next Ellik irrigation was used to irrigate out the organized clots. This aided visualization as things were reinspected. Next the Holmium laser with 1000 fiber was used at predominately power level 1200 at 10 hertz and stone dissolution was achieved. Ellik irrigation and a pistons syringe were used to evacuate the stone fragments which were sent to pathology. Next the 26 French resectoscope was passed and the bladder diverticulum tumor was resected. Care was taken not to perforate the thin diverticula wall. The right ureteral orifice appeared patent and separate from the resection. The roller ball electric was passed and the diverticulum lining was coagulated with the roller ball for hemostasis. The bladder tumor chips were evacuated and sent to pathology. The bladder was drained with a 26 three way Foley catheter for continuous bladder irrigation.
My problem is this: in the Title of Procedure the doctor stated, "Cystolitholapaxy with laser lithotripsy to help the bladder stone and TURBT large."
I cannot find any documentation to support using the cystolitholapaxy code 52317. But if I can use it, then would it be appropriate to bill the lithotripsy 52353 and the cystolitholapaxy 52317?
The codes that were chosen were:
52240
52353
52317-59
52001-59
I just don't think that these are the right codes.
Any help would be appreciated.
Thanks.
Hoping I can get help with this procedure. Here is the op note dictation:
The 25 French cystoscope was passed under camera vision. No anterior urethral abnormalities were identified. There was mild prosthetic regrowth. There was now wide core vesical neck contracture. The urinary bladder was entered. The right and left ureteral orifices were in normal position. There is a large brown bladder calculus measuring approximately 2cm. There is a bladder diverticulum lateral to the ureteral orifice with a large papillary bladder tumor which coated the lining of this diverticulum. No other bladder tumors were identified. Next Ellik irrigation was used to irrigate out the organized clots. This aided visualization as things were reinspected. Next the Holmium laser with 1000 fiber was used at predominately power level 1200 at 10 hertz and stone dissolution was achieved. Ellik irrigation and a pistons syringe were used to evacuate the stone fragments which were sent to pathology. Next the 26 French resectoscope was passed and the bladder diverticulum tumor was resected. Care was taken not to perforate the thin diverticula wall. The right ureteral orifice appeared patent and separate from the resection. The roller ball electric was passed and the diverticulum lining was coagulated with the roller ball for hemostasis. The bladder tumor chips were evacuated and sent to pathology. The bladder was drained with a 26 three way Foley catheter for continuous bladder irrigation.
My problem is this: in the Title of Procedure the doctor stated, "Cystolitholapaxy with laser lithotripsy to help the bladder stone and TURBT large."
I cannot find any documentation to support using the cystolitholapaxy code 52317. But if I can use it, then would it be appropriate to bill the lithotripsy 52353 and the cystolitholapaxy 52317?
The codes that were chosen were:
52240
52353
52317-59
52001-59
I just don't think that these are the right codes.
Any help would be appreciated.
Thanks.