Nephroureteral Stent Repair


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History: Malfunctioning painful nephroureteral stent.

1. Right nephrostogram

Procedure Note:Risks and benefits as well as alternatives of
percutaneous nephrostogram were discussed with this patient that has
had this NephroUreteral tube for approximately 6 weeks and informed
consent was obtained. With the patient prone the right flank as well
as the existing nephroureteral tube were prepped and draped in a
sterile fashion.

Right nephrostogram: Initial fluoroscopy demonstrates that the
nephroureteral stent has migrated distally and the distal loop is now
exiting the patient's ileal conduit stoma. Additionally, the distal
loop of the stent appears to be kinked. Small volume contrast
injection through the existing nephroureteral stent demonstrates
slightly dilated calyxes with excellent drainage into the bladder.
There is no obstruction identified.

Nephroureteral stent repair: The patient's stoma bag was removed and
the kinked catheter was initially unkinked and subsequently cut so
that the modification removed the distal pigtail loop allowing for
the nephroureteral stent to return back into the ileal conduit
itself. At this point the patient experienced considerable relief.
The site was prepped and draped in a sterile fashion. The retaining
suture was cut. External drainage bag was removed. A new sterile
dressing was applied.

Impression: Nephroureteral stent had migrated distally and was most
likely applying pressure to the patient and the collecting system,
resulting in pain. Modification of the nephroureteral stent allowed
for patient comfort and continued internal drainage.

Is there a code for the stent repair? or is this just coded 50394 and 74425?