Very confused on this one. Need help please

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Hello all! I am not sure how to code this. Any help is appreciated!!

50390-59, 74425
50393,-51 74480 (I bill outpatient for a hospital, does 51 even apply?)
50688, 75984

Would you add a Mod 51 for multiple procedures or would you consider that the stent placement 50393 was just part of the final procedure of the stent change, 50688. Our docs usually doing this staged. 50393 one day and the 50688 the next. But for some reason it was all done at the same session.
Thanks! Sue

Left-sided percutaneous nephrostomy with left ureterogram; fluoroscopic guided traversal of ureteral-ileal conduit anastomotic stenosis and passage of wire through the ileal conduit; retrograde nephroureteral catheter placement through ileal conduit and removal of percutaneous nephrostomy.

History: Bladder cancer with ileal conduit and left-sided ileal conduit-ureter anastomotic stricture.

Technique: Timeout was performed. Skin over left flank prepped and draped sterilely. 2% lidocaine used as a local anesthetic. Moderate sedation also administered. Ultrasound used to determine potential access sites and for real-time guidance into a left lower pole calyx. Images recorded and made part of the patient's permanent medical record. Urine was sampled and sent to the lab for analysis. Antegrade pyelogram was performed. Wire advanced under fluoroscopic guidance down the ureter and exchanged for a catheter. Ureterogram was performed. Wire and catheter were advanced into the ileal conduit and the ostomy bag was removed. This area was prepped and draped sterilely. Wire was advanced through the conduit outside the patient's skin and accessed with a forcep. Percutaneous ureteral catheter was removed. Over a wire in a retrograde fashion through the ileal conduit, an 8.5-French 45 cm multipurpose catheter was advanced under fluoroscopic guidance into the renal pelvis. Wire was removed. Completion nephrostogram performed. No complications occurred.

Findings: There is moderate left-sided hydroureteronephrosis. Needle was seen coursing into a lower pole calyx. Antegrade pyelogram shows moderately severe hydroureteronephrosis. The urine appeared purulent and was sent to the lab for analysis. Left-sided ureterogram shows obstruction of the distal left ureter at the L5-S1 level, near the ureteral ileal conduit anastomosis. This was traversed with a catheter and wire. Retrograde placement of a nephroureteral stent is seen within the renal pelvis in excellent position with the distal portion out the conduit into the ostomy bag. There is mild hydronephrosis. Catheter is in excellent position.

Result Impression
Successful placement of a retrograde nephroureteral catheter through an ileal conduit after initial access was made from a percutaneous left-sided nephrostomy catheter placement. There is a ureteral - ileal conduit anastomotic stricture.
 

dpeoples

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--------------------------------------------------------------------------------

Hello all! I am not sure how to code this. Any help is appreciated!!

50390-59, 74425
50393,-51 74480 (I bill outpatient for a hospital, does 51 even apply?)
50688, 75984

Would you add a Mod 51 for multiple procedures or would you consider that the stent placement 50393 was just part of the final procedure of the stent change, 50688. Our docs usually doing this staged. 50393 one day and the 50688 the next. But for some reason it was all done at the same session.
Thanks! Sue

Left-sided percutaneous nephrostomy with left ureterogram; fluoroscopic guided traversal of ureteral-ileal conduit anastomotic stenosis and passage of wire through the ileal conduit; retrograde nephroureteral catheter placement through ileal conduit and removal of percutaneous nephrostomy.

History: Bladder cancer with ileal conduit and left-sided ileal conduit-ureter anastomotic stricture.

Technique: Timeout was performed. Skin over left flank prepped and draped sterilely. 2% lidocaine used as a local anesthetic. Moderate sedation also administered. Ultrasound used to determine potential access sites and for real-time guidance into a left lower pole calyx. Images recorded and made part of the patient's permanent medical record. Urine was sampled and sent to the lab for analysis. Antegrade pyelogram was performed. Wire advanced under fluoroscopic guidance down the ureter and exchanged for a catheter. Ureterogram was performed. Wire and catheter were advanced into the ileal conduit and the ostomy bag was removed. This area was prepped and draped sterilely. Wire was advanced through the conduit outside the patient's skin and accessed with a forcep. Percutaneous ureteral catheter was removed. Over a wire in a retrograde fashion through the ileal conduit, an 8.5-French 45 cm multipurpose catheter was advanced under fluoroscopic guidance into the renal pelvis. Wire was removed. Completion nephrostogram performed. No complications occurred.

Findings: There is moderate left-sided hydroureteronephrosis. Needle was seen coursing into a lower pole calyx. Antegrade pyelogram shows moderately severe hydroureteronephrosis. The urine appeared purulent and was sent to the lab for analysis. Left-sided ureterogram shows obstruction of the distal left ureter at the L5-S1 level, near the ureteral ileal conduit anastomosis. This was traversed with a catheter and wire. Retrograde placement of a nephroureteral stent is seen within the renal pelvis in excellent position with the distal portion out the conduit into the ostomy bag. There is mild hydronephrosis. Catheter is in excellent position.

Result Impression
Successful placement of a retrograde nephroureteral catheter through an ileal conduit after initial access was made from a percutaneous left-sided nephrostomy catheter placement. There is a ureteral - ileal conduit anastomotic stricture.
I agree with your code choices except 75984, no contrast was injected (required for this cpt) at this stage of the procedure. This is unusual but as documented, 50393 and 50688 do apply, IMO. And, yes, I would apply the 51 modifier.
HTH :)
 
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