Wiki Percutaneous Nephrostomy Tubes?

[toria11]

Hi! I'm a bit stumped on this one. I was thinking:
50081-RT
74420-26

Would it be appropriate to bill 50389-RT for the removal of the right nephrostomy tube?

POSTOPERATIVE DIAGNOSES: Bilateral hydronephrosis, right renal calculus, and
left hydronephrosis.
PROCEDURES PERFORMED: Cysto, right ureteroscopy using the flexible
scope, laser lithotripsy, stone extraction, stent
placement followed by right percutaneous
nephrostomy tube removal, then we did a left
ureteroscopy retrograde, attempted left ureteral
stent placement unsuccessful.
ANESTHESIA: General.
DETAILS OF PROCEDURE: The scope was placed in the bladder without difficulty. The patient had
bilateral nephrostomy tubes. She did have a right renal calculus and a flexible ureteroscope was used to
go up into the kidney and using the laser lithotripsy, we were able to fragment the stone into several pieces
and the largest fragment, we were able to remove. Once this was performed, we then placed a 6 x 24
stent. We then turned our attention to the left side. At this time, we did a retrograde and dye stop acutely
right at the passing of the vessels. We took the scope right up to that area and we tried to pass a
guidewire through what was appeared to be dense stricture. We were unable to get through that area.
We tried to pass dye. We were unable to pass guide through that. Therefore, we felt that the stricture
was too long. So therefore at this time, we left percutaneous nephrostomy tube in place and the level of
the right side was removed, so at the end of the procedure, she had a left percutaneous nephrostomy tube
and a right internal stent. Procedure was terminated. The patient was sent to PAR in stable condition.

 

[nickelclaw]

Hello,
You are on right path and 50081-RT is correct this includes stent placement. The 50389 would be used if tube was removed and stent was placed as the only procedure. Look into the 50432-LT instead of the radiology code which is for a urogram. The retrograde was still done through tube and since on the other side may bill together. The header states attempted to place stent on left which would be the 50389; this was unable to be done so just code procedure that was completed and dye was done 50432. Documentation doesn't sound like the stent was able to be attempted if it did then you would code the 50389-74 or 53 for profee. Hope this helps!

 

[liqgold2@aol.com]

The operative report does not describe procedures reported as performed. With this in mind I would suggest the following coding based on the poor operative report:
52356 for the ureteroscopy, stone fragmentation and removal
50951 for the retrograde ureteroscopy. stent not placed.
I would conside 50081 not really performed in this case