Pcnl

[KaylaRieken]

So I have a patient that had a percutaneous nephrolithotomy (50080) done. A week later she came back in and had some more stones removed. Dr listed the procedure as Second left percutaneous nephrolithotomy, Left antegrade nephrostogram, and Left nephrostomy tube removal. My question is what code to use for the second stage procedure. Do I use 50561?

 

[nateich]

Why not the same code with -76? If in fact, PCNL was performed again.

 

[KaylaRieken]

I was debating on using the 50080 again, but the Dr went through the same access tract and didn't establish a new one (was my thinking for the 50561)

A flexible cystoscope was used as a nephroscope to enter the collecting system with no difficulty down the established tract. Fluroscopy was used intermittently throughout for exposure. We did inject contrast to outline the collecting system and each and every calyceal branch was carefully inspected. The cluster of a few small fragments appear to be residing within one of the lower pole caliceal branches which I think correlated with the CT scan findings. It was not thus one large stone but rather several fragments. These were able to be irrigated free and essentially flushed free from the collecting system. The UPJ appeared to be free of stone and there appeared to be nice transport of contrast down the ureter with antegrade nephrostogram injection.

 

[anncrickenberger]

PCNL - 2nd stage

For second stage - look at :
50951 – Ureteral endoscopy thru estab ureterstomy
50961 – w/ removal of stone
50551 – Renal endoscopy thru estab nephrostomy
50561 – w/ removal of stone
50394 – Nephrostogram if done
74425, 26, Reading of (add 59 if retrograde is done also)