Can we code the following procedure with 50688 & 75984? Do anyone have any other suggestions?
History: Patient is an 80-year-old male with bladder cancer and
urinary diversion through a ileal loop, left ureteral stricture
status post placement of a reverse left nephrostomy tube through
the stoma into the left renal collecting system referred for
routine catheter exchange.
Approach: Retrograde access through the stoma
Procedure: Continuous physiological monitoring was carried out
throughout the procedure. With the patient in the supine position
the stoma was prepped and draped in the usual sterile fashion.
The indwelling nephrostomy tube is noted to have retracted into
the stoma. It was retrieved under fluoroscopic guidance using a
clamp. A catheter nephrostogram was performed. Under fluoroscopic
guidance the indwelling catheter was removed over a stiff
guidewire and a new 10 French pigtail self retaining
nephroureteral stent was placed with its distal tip in the renal
pelvis and proximal loop formed within the ileal loop. Aspirated
urine was clear. A completion nephrostogram was performed. The
catheter was left to gravity drainage within the bag. The
patient tolerated the procedure without incident.
Findings: The nephrostogram demonstrated minimal hydronephrosis
with little visualization of the left ureter. There is flow of
contrast down the catheter into the ileal loop.
Conclusion: Fluoroscopically guided replacement of a left 10
French reverse nephrostomy catheter for a new 10-French by 24-cm
left reverse nephroureteral stent with its distal tip within the
renal pelvis and proximal loop within the ileal loop. The stent
exits the stoma to be placed to bag drainage within the ostomy
drainage bag.
History: Patient is an 80-year-old male with bladder cancer and
urinary diversion through a ileal loop, left ureteral stricture
status post placement of a reverse left nephrostomy tube through
the stoma into the left renal collecting system referred for
routine catheter exchange.
Approach: Retrograde access through the stoma
Procedure: Continuous physiological monitoring was carried out
throughout the procedure. With the patient in the supine position
the stoma was prepped and draped in the usual sterile fashion.
The indwelling nephrostomy tube is noted to have retracted into
the stoma. It was retrieved under fluoroscopic guidance using a
clamp. A catheter nephrostogram was performed. Under fluoroscopic
guidance the indwelling catheter was removed over a stiff
guidewire and a new 10 French pigtail self retaining
nephroureteral stent was placed with its distal tip in the renal
pelvis and proximal loop formed within the ileal loop. Aspirated
urine was clear. A completion nephrostogram was performed. The
catheter was left to gravity drainage within the bag. The
patient tolerated the procedure without incident.
Findings: The nephrostogram demonstrated minimal hydronephrosis
with little visualization of the left ureter. There is flow of
contrast down the catheter into the ileal loop.
Conclusion: Fluoroscopically guided replacement of a left 10
French reverse nephrostomy catheter for a new 10-French by 24-cm
left reverse nephroureteral stent with its distal tip within the
renal pelvis and proximal loop within the ileal loop. The stent
exits the stoma to be placed to bag drainage within the ostomy
drainage bag.
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