Nephrostomy

prabha

Guru
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Do we need to code nephrostogram(50394) for the following procedure?

History: 55-year-old male with bladder cancer status post right
nephrostomy tube placement ,presents with
inadvertent withdrawal of his nephrostomy tube. He is referred
for nephrostomy tube placement.

Procedure:With the patient in the prone position
the right flank was prepped and draped in the usual sterile
fashion. A Berenstein catheter and a hydrophilic guidewire were
advanced through the previous catheter tract. Contrast injection
through the catheter demonstrates an irregular catheter tract
which communicates with the renal collecting system. The
hydrophilic guidewire was advanced into the renal collecting
system and guided down the ureter. After exchanging for a stiff
glide wire, an 8-French pigtail nephrostomy catheter was placed
and its tip formed in the renal pelvis. Aspirated urine was
cloudy. A completion nephrostogram was performed. The catheter
was sutured to the skin using a 2-0 proline suture and left to
gravity drainage. The patient tolerated the procedure without
incident.

Findings: The nephrostogram demonstrated minimal right
hydronephrosis with distal ureteral obstruction.

Conclusion: Fluoroscopically guided replacement of an 8 French pig
tail right nephrostomy catheter as described above.
 

dhuston

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You would code 50398/75984 for an exchange of the nephrostomy because the track from the other tube was there. If it hadn't been there it would have been a new nephrostomy tube placement. You can code 50394/74425 for the nephrostogram because your doctor says it was a nephrostogram and gives an interp.

Diane Huston, CPC,RCC
 
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