toria11
Guru
This one is stumping me. The physician suggested 50081 and 52332 but is asking for an additional code for the ureteral incision and removal of stone. Would this be included in 50081? Thank you!!
PROCEDURES PERFORMED:
1. Cystoscopy.
2. Left ureteral incision.
3. Left ureteral stone removal.
4. Left retrograde pyelogram.
5. Fluoroscopy.
6. Left ureteral stent placement, 6 x 26 double J
7. Urethral dilation.
PERTINENT FINDINGS:
1. Completely obliterated left distal ureteral orifice.
2. Indwelling nephroureteral tube appeared to have distal coil at the left distal ureter without access into
the bladder.
3. Manipulation of the nephroureteral tube with a wire passed from antegrade approach identified the
location of the ureteral orifice.
4. Successful incision using the hot knife at the access to the left ureteral orifice and his left distal blown
out ureter with several large stones located with it.
5. Successful removal of the stones.
6. Successfully access of the entire left collecting system.
7. Removal of the left nephroureteral tube with placement of a new 6 x 26 double J ureteral stone on the
left.
INDICATIONS FOR PROCEDURE: Male with a history of bladder cancer with inability to access the left collecting system due to completely obliterated ureteral orifice. He
has a history of high-grade T1 urethral carcinoma as well as CIF completing BCG. However, he was
found to have left side hydronephrosis on this left distal stone without any ability to access the left distal
ureter and therefore underwent nephroureteral tube with interventional radiology and now presents for
treatment from a retrograde approach.
PROCEDURE IN DETAIL: After proper informed consent was obtained, the patient was brought to
the operating room and laid supine on the operating room table. The patient was placed under general
anesthesia. The patient was placed in the lithotomy position and prepped and draped in a standard sterile
fashion. After proper time-out was completed, a rigid cystoscope was inserted through the urethra into
the bladder. The urethra mucosa was within limits throughout abnormalities or lesions identified. Upon
entering the bladder, the right ureteral orifice was identified however, the left ureteral orifice was unable to
be identified. Fluoroscopy identified the nephroureteral tube appearing to be coiling within the bladder
however, there was no evidence of this nephroureteral tube into the bladder. It was likely behind the
bladder in the distal ureter located where the stones had created a significant hydroureter. At this point, it
was decided to approach from antergrade. The nephroureteral tube was excess from the left flank and
the wire was passed down. The wire was advanced all the way to the left distal coil, however unable to
access into the bladder. At this point, because of this, it was then decided to use to open up the left distal
ureter. This was done successfully where the immediate access to the left nephroureteral tube and wire.
The wire was then successfully passed all the way from the left flank all the way through to the urethra.
The stones were looking in the left distal ureteral were successfully removed given the significant size of
the distal ureter and the hydroureter. The distal ureteral orifice was incised and opened up adequately and
a new 6 x 26 double J ureteral stent was successfully placed into the left collecting system with removal of
the nephroureteral tube and wire. Prior to doing so, retrograde was completely which identified no
evidence of extravasation of the left renal pelvis. There was good coil of this 6 x 26 double J ureteral
stent in the left renal pelvis and bladder. The stones were removed from the bladder and a Foley catheter
was then placed. The patient tolerated the procedure well with no complications. He was awoken from
anesthesia and taken to PACU in good stable and condition.
PROCEDURES PERFORMED:
1. Cystoscopy.
2. Left ureteral incision.
3. Left ureteral stone removal.
4. Left retrograde pyelogram.
5. Fluoroscopy.
6. Left ureteral stent placement, 6 x 26 double J
7. Urethral dilation.
PERTINENT FINDINGS:
1. Completely obliterated left distal ureteral orifice.
2. Indwelling nephroureteral tube appeared to have distal coil at the left distal ureter without access into
the bladder.
3. Manipulation of the nephroureteral tube with a wire passed from antegrade approach identified the
location of the ureteral orifice.
4. Successful incision using the hot knife at the access to the left ureteral orifice and his left distal blown
out ureter with several large stones located with it.
5. Successful removal of the stones.
6. Successfully access of the entire left collecting system.
7. Removal of the left nephroureteral tube with placement of a new 6 x 26 double J ureteral stone on the
left.
INDICATIONS FOR PROCEDURE: Male with a history of bladder cancer with inability to access the left collecting system due to completely obliterated ureteral orifice. He
has a history of high-grade T1 urethral carcinoma as well as CIF completing BCG. However, he was
found to have left side hydronephrosis on this left distal stone without any ability to access the left distal
ureter and therefore underwent nephroureteral tube with interventional radiology and now presents for
treatment from a retrograde approach.
PROCEDURE IN DETAIL: After proper informed consent was obtained, the patient was brought to
the operating room and laid supine on the operating room table. The patient was placed under general
anesthesia. The patient was placed in the lithotomy position and prepped and draped in a standard sterile
fashion. After proper time-out was completed, a rigid cystoscope was inserted through the urethra into
the bladder. The urethra mucosa was within limits throughout abnormalities or lesions identified. Upon
entering the bladder, the right ureteral orifice was identified however, the left ureteral orifice was unable to
be identified. Fluoroscopy identified the nephroureteral tube appearing to be coiling within the bladder
however, there was no evidence of this nephroureteral tube into the bladder. It was likely behind the
bladder in the distal ureter located where the stones had created a significant hydroureter. At this point, it
was decided to approach from antergrade. The nephroureteral tube was excess from the left flank and
the wire was passed down. The wire was advanced all the way to the left distal coil, however unable to
access into the bladder. At this point, because of this, it was then decided to use to open up the left distal
ureter. This was done successfully where the immediate access to the left nephroureteral tube and wire.
The wire was then successfully passed all the way from the left flank all the way through to the urethra.
The stones were looking in the left distal ureteral were successfully removed given the significant size of
the distal ureter and the hydroureter. The distal ureteral orifice was incised and opened up adequately and
a new 6 x 26 double J ureteral stent was successfully placed into the left collecting system with removal of
the nephroureteral tube and wire. Prior to doing so, retrograde was completely which identified no
evidence of extravasation of the left renal pelvis. There was good coil of this 6 x 26 double J ureteral
stent in the left renal pelvis and bladder. The stones were removed from the bladder and a Foley catheter
was then placed. The patient tolerated the procedure well with no complications. He was awoken from
anesthesia and taken to PACU in good stable and condition.
Do you have any advice or direction you could point me in? He does mention he incised the ureter with a hot knife to gain access to the nephroureteral tube and that's how he reached the stones/placed the stent.