Wiki Stent Removal

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KaylaRieken

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Patient is in the post op period of an ESWL. This happened in the outpatient surgery department. No cystoscope was used.

After informed consent and after the nurse had injected intravenous viscous lidocaine, it was noted that the curl of the distal portion of the ureteral stent was actually just outside of the urethral meatus and visible. Therefore, I was able to simply grasp this with my gloved fingers, and I removed the stent without complication and difficulty.

Would i just code this 99024 for the physician part?
 
I've never heard of stents being placed during an ESWL procedure - this stent would likely have been from a different procedure, so the removal would likely be unrelated to the ESWL itself. But in any case, the wasn't really a procedure done here since the stent was already partially outside the body, so I don't think there's any procedure to assign just for this - I would consider it part of the E&M, if anything.
 
Our physicians place ureteral stents when doing ESWLS quite often. I think in this cause I am just going to have go with 99024?
 
An ESWL procedure does not access the ureter for stent placement. Are they performing a cystoscopy in the same session as the ESWL to put in a stent? I've never seen this done. Or when you say ESWL are you talking about a cystoscopy/ureteroscopy with lithotripsy and stent placement? It makes a different in this situation because the ESWL (CPT 50590) has a global period but the lithotripsy done via cystoscopy/ureteroscopy (CPT 52356) does not. So it the stent was placed during the cystoscopy, the removal would not be related to the ESWL.
 
KaylaRieken said:
Yes 50590 and the cysto stent placement 52332.
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Since the stent placement 52332 has no global period, the removal of the stent would be outside the global period and would be unrelated to the ESWL and a modifier 24 or 79 could be supported. But your employer might want to give you guidance on this. If the bulk of the follow-up visit is routine post-ESWL care and the stent removal is just incidental, they may not wish you to charge separately for that minor service.
 
There should be no charge for this stent removal. Stents are often placed as part of an ESWL procedure.
Michael A. Ferragamo MD, FACS, urologist and Urological coding and reimbursement consultant.
 
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