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Thread: Nephrostomy-Can we code the

  1. #1

    Default Nephrostomy-Can we code the

    Promo: Code Books
    Can we code the following procedure with

    50392
    50394
    50688
    74475-26
    74425-26
    75984-26

    Kindly confirm.


    Left Percutaneous Nephrostomy Tube Internalization:

    Patient admitted for left sided hydronephrosis with an
    antegrade nephrostogram demonstrating a distal left ureteral
    stenosis now status post left-sided percutaneous nephrostomy tube
    placement. Patient referred for left sided percutaneous
    nephrostomy tube internalization.

    Initial scout images demonstrates a left flank pigtail catheter in
    the expected location of the left renal pelvis.
    The left flank, including the indwelling nephrostomy tube, was
    prepped and draped in the usual sterile fashion. The nephrostomy
    tube was then aspirated until clear. A gentle injection of
    contrast through the nephrostomy tube was then performed to obtain
    an antegrade nephrostogram. Multiple spot images were obtained.

    This demonstrated good positioning of the nephrostomy tube with
    its distal pigtail coiled within the left renal pelvis. No
    hydroureteronephrosis is identified. There is complete occlusion
    of the distal left ureter at the level of the ureteroenteric
    anastomosis.

    After the administration of local anesthesia, the catheter was
    then cut and removed over an Amplatz wire. A 4-French glide
    Berenstein catheter was then advanced over the wire and positioned
    within the renal pelvis. The Amplatz wire was then exchanged for
    a Glidewire and the catheter and Glidewire were used to select the
    left ureter. The catheter was advanced over the Glidewire and
    positioned within the distal left ureter at the level of the
    obstruction.

    The Glidewire was exchanged for an Amplatz wire. The catheter was
    then exchanged for a 7-French long sheath. The 4-French glide
    Berenstein catheter was then readvanced over the wire and the
    catheter and Glidewire were used to attempt to cross the occluded
    distal left ureter. The Glidewire was then advanced beyond the
    obstruction and the catheter was advanced over the wire. A gentle
    injection of contrast was then performed which demonstrated a
    false passage with contrast flowing into the peritoneum
    surrounding loops of bowel.

    The catheter was then pulled back into the distal left ureter
    central to the occlusion. An 018 gold tip Glidewire was then
    coaxially loaded through a 3-French catheter. The catheter and
    Glidewire were then coaxially loaded through the glide Berenstein
    catheter. The 018 gold tip Glidewire was then used to cross the
    occluded distal left ureter over which the 3-French microcatheter
    was advanced. The 018 glide wire was then removed.

    A gentle injection of contrast was then performed through the
    microcatheter which demonstrated ileal folds confirming good
    positioning of the microcatheter within the ileal conduit.

    A V18 wire was then advanced through the microcatheter and into
    the ileal conduit. The 4-French glide Berenstein catheter was
    then advanced over the wire and microcatheter and into the ileal
    conduit. The V18 wire and microcatheter were removed. A gentle
    injection of contrast confirmed good positioning of the catheter
    within the ileal conduit.

    The wire was then readvanced through the 4-French glide Berenstein
    catheter. The catheter and Glidewire were then advanced through
    the ileal conduit and used to cannulate the ileal conduit stoma.
    The Glidewire was removed a gentle injection of contrast was
    performed. This demonstrated free flow of contrast into the ileal
    conduit bag confirming good positioning of the glide Berenstein
    catheter outside the ileal conduit.

    An Amplatz wire was then advanced through the catheter and out the
    ileal conduit stoma to obtain through and through access.

    The catheter and sheath were then removed and the distal tip of
    the Amplatz wire were secured to the patient. The patient was
    then repositioned into the supine position on the fluoroscopic
    table.

    The right lower quadrant, including the indwelling ileal conduit
    stoma and through and through Amplatz wire, was then prepped and
    draped in the usual sterile fashion.

    A 10-French by 45-cm multi-sidehole pigtail drainage catheter was
    then advanced over the wire and positioned with its distal pigtail
    coiled within the left renal pelvis. The Amplatz wire was then
    removed and a gentle injection of contrast confirmed good
    positioning the retrograde nephroureteral stent with its distal
    pigtail coiled within the left renal pelvis.

    The catheter was then aspirated until clear and flushed with 10 cc
    normal saline.

    The ileal conduit ostomy bag was then repositioned over the stoma
    with the distal tip of the retrograde nephroureteral stent within
    the ostomy bag.

    Impression:
    Left-sided antegrade nephrostogram demonstrating occlusion of the
    distal left ureter at the level of the ureteroenteric anastomosis.

    Successful cannulation of the occluded left-sided ureteroenteric
    anastomosis and internalization with a 10 French x 45 cm
    multi-sidehole pigtail catheter retrograde nephroureteral stent as
    described above.
    Prabha CPC

  2. #2

    Default

    I'm thinking an internalization of a neph. tube to a nephroureteral stent would be 74480/50393...

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