Wiki Need CPT codes for Endoureterotomy

[commitsvs]

1.Right Endoureterotomy 2. Endopyelotomy 3.right ureteroscopic LASER LITHOTRIPSY AND STONE EXTRACTION 4. Retrograde BALLOON DILATION, Right, 5. Right stent insertion and right stent removal.

I am confused with CPT 52356 and 50951,52282. Please help me what would be the correct CPTs

 

[nickelclaw]

Need op note

 

[commitsvs]

Procedure performed:
Bilateral ureteroscopic laser incision and endopyelotomy x2 with modifier 50; 2. Left URETEROSCOPIC STONE EXTRACTION WITH
LASER LITHOTRIPSY PROXIMAL URETERAL STONE 3. LEFT URETEROSCOPIC STONE EXTRACTION LASER LITHOTRIPSY OF LEFT
KIDNEY STONES 4. FLUOROSCOPY LESS THAN 1 HOUR 5. BILATERAL STENT PLACEMENT X2 WITH MODIFIER 50. 6. BILATERAL
STENT REMOVAL TIMES MODIFIER 50; 7. bilateral retrograde pyelogram x2 with modifier 50; 8. Complex Foley catheter insertion and
irrigation of the bladder
Indications:

Patient is here for bilateral ureteroscopy and bilateral endopyelotomy with ureteroscopic stone extraction.

Procedure:
After informed consent was obtained from the patient patient was then brought to the operating room. LMA anesthesia was performed by
the anesthesia team patient was given 1 g of ceftriaxone for preoperative antibiotics. Patient was then placed in the lithotomy position
prepped and draped in the usual sterile fashion. We started with a 23 French ACMI cystoscope once we performed a cystoscopy we
identified previously inserted right double-J stent this was grasped using alligator forceps and exchanged over guidewire. We shot a
retrograde pyelogram which showed that patient had a severe hydroureter and hydronephrosis secondary to UPJ obstruction. We then
used a semirigid ureteroscope to perform a ureteroscopy and at the proximal ureter using a thulium fiber laser at the UPJ obstruction was
incised and dilated. Once the UPJ obstruction was in size and dilated, we then placed a 8.5 x 28 black anterior was coiled in the collecting
system as well as the bladder. Due to his previous history of. It was confirmed to be coiled in the collecting system as well as the bladder.

Following this procedure we then reinserted a 23 French ACMI cystoscope once we got into the bladder we identified previously inserted
left double-J stent this was then grasped using alligator forceps and exchanged over guidewire. We shot a retrograde pyelogram which
showed that patient had a mild UPJ obstruction along with proximal ureteral stone and left kidney stones. We then placed the semirigid
ureteroscope and identified a proximal ureteral stone this was then laser lithotripsied and basketed and removed once we cleared the
ureteral stone we able to place a Super Stiff guidewire followed by 1214 French ureteral sheath into the collecting system. We then
performed a pyeloscopy of the upper pole calyx midpole calyx in the lower pole calyx at the midpole posterior calyx we identified a calyceal
diverticulum filled with stones. This was then laser lithotripsied and basketed into multiple pieces and then removed. Once we cleared this
and cleared all the rest of his stones in the kidneys, we then laser incised the UPJ obstruction on the left side as well. We then placed a 8.5
x 28 black beauty stent under fluoroscopy and cystoscopic guidance under was coiled in the collecting system as well as the bladder.

Due to his previous history of acute renal failure we then placed a 20 French council tip Foley catheter directly into the bladder and we then
shot a retrograde cystogram using 200 cc of diluted contrast. There was no evidence of any bladder extravasation and both stents were
draining well. Patient was awakened and taken back to the recovery room in stable condition. Patient will be admitted 23 hours for
observation