Does the below procedure is performed through ileostomy and can we code this as 50688 & 50684??
Clinical history: Patient is a 83-year-old female with a history
of bladder cancer s/p radical resection and ileal conduit who had
a percutaneous nephroureterostomy placed 07/20/2010 due to
moderate left hydronephrosis. Request for conversion of
percutaneous nephroureterostomy to upside down nephrostomy.
Procedure: Nephrostogram
Exchange of nephroureterostomy for upside down nephrostomy
Total
fluoroscopy time 3.1 minutes.
The patient was placed on the angiography table in a right lateral
position. The left flank and the external portion of existing
nephroureterostomy were double prepped and draped in the usual
sterile fashion. The ostomy site was also prepped and draped with
sterile towels.
Preliminary scout demonstrates a catheter with pigtail formed in
the flank and pelvis. Contrast was injected through the existing
nephroureterostomy demonstrating proper positioning. Under
fluoroscopic guidance, a stiff guidewire was advanced through the
catheter and exchange was made for a 7 French sheath. Contrast was
injected confirming position with in the renal collecting system.
A 4 French Berenstein catheter was advanced over the guidewire
into the ileal conduit. A Glidewire was then used to advance the
catheter out the ostomy. An Amplatz wire was then advanced into
the renal pelvis. Exchange was then made for an 8.5 French, 45 cm
long all-purpose drainage catheter. Contrast was then injected via
the catheter to confirm position. A sterile dressing was applied.
The ostomy bag was replaced and the drainage catheter was noted to
be successfully draining into the ostomy bag.
The patient tolerated the procedure well and left the department
in stable condition; no immediate complications.
Impression: Successful conversion of percutaneous
nephroureterostomy to 8.5F, 45cm long upside-down nephrostomy.
Clinical history: Patient is a 83-year-old female with a history
of bladder cancer s/p radical resection and ileal conduit who had
a percutaneous nephroureterostomy placed 07/20/2010 due to
moderate left hydronephrosis. Request for conversion of
percutaneous nephroureterostomy to upside down nephrostomy.
Procedure: Nephrostogram
Exchange of nephroureterostomy for upside down nephrostomy
Total
fluoroscopy time 3.1 minutes.
The patient was placed on the angiography table in a right lateral
position. The left flank and the external portion of existing
nephroureterostomy were double prepped and draped in the usual
sterile fashion. The ostomy site was also prepped and draped with
sterile towels.
Preliminary scout demonstrates a catheter with pigtail formed in
the flank and pelvis. Contrast was injected through the existing
nephroureterostomy demonstrating proper positioning. Under
fluoroscopic guidance, a stiff guidewire was advanced through the
catheter and exchange was made for a 7 French sheath. Contrast was
injected confirming position with in the renal collecting system.
A 4 French Berenstein catheter was advanced over the guidewire
into the ileal conduit. A Glidewire was then used to advance the
catheter out the ostomy. An Amplatz wire was then advanced into
the renal pelvis. Exchange was then made for an 8.5 French, 45 cm
long all-purpose drainage catheter. Contrast was then injected via
the catheter to confirm position. A sterile dressing was applied.
The ostomy bag was replaced and the drainage catheter was noted to
be successfully draining into the ostomy bag.
The patient tolerated the procedure well and left the department
in stable condition; no immediate complications.
Impression: Successful conversion of percutaneous
nephroureterostomy to 8.5F, 45cm long upside-down nephrostomy.