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  1. Default Nephrostomy
    Medical Coding Books
    Do we need to code nephrostogram(50394) for the following procedure?

    History: 55-year-old male with bladder cancer status post right
    nephrostomy tube placement ,presents with
    inadvertent withdrawal of his nephrostomy tube. He is referred
    for nephrostomy tube placement.

    Procedure:With the patient in the prone position
    the right flank was prepped and draped in the usual sterile
    fashion. A Berenstein catheter and a hydrophilic guidewire were
    advanced through the previous catheter tract. Contrast injection
    through the catheter demonstrates an irregular catheter tract
    which communicates with the renal collecting system. The
    hydrophilic guidewire was advanced into the renal collecting
    system and guided down the ureter. After exchanging for a stiff
    glide wire, an 8-French pigtail nephrostomy catheter was placed
    and its tip formed in the renal pelvis. Aspirated urine was
    cloudy. A completion nephrostogram was performed. The catheter
    was sutured to the skin using a 2-0 proline suture and left to
    gravity drainage. The patient tolerated the procedure without

    Findings: The nephrostogram demonstrated minimal right
    hydronephrosis with distal ureteral obstruction.

    Conclusion: Fluoroscopically guided replacement of an 8 French pig
    tail right nephrostomy catheter as described above.
    Prabha CPC

  2. Default
    You would code 50398/75984 for an exchange of the nephrostomy because the track from the other tube was there. If it hadn't been there it would have been a new nephrostomy tube placement. You can code 50394/74425 for the nephrostogram because your doctor says it was a nephrostogram and gives an interp.

    Diane Huston, CPC,RCC

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