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Nephrostomy-Pls clarify the codes

  1. Default Nephrostomy-Pls clarify the codes
    Medical Coding Books
    Hi all,

    Pls clarify the codes for the procedure performed.

    INFORMATION:
    Internal/externa nephroureteral stent in place, patient had urinoma and ureteral injury, nephroureteral i place approximately one week.
    Consent was obtained. 1% lidocaine utilized as local anesthesia. Divided doses of ed and fentanyl were utilized for conscious sedation. The patient’s cardiovascular ored. Procedure time was less than 30 minutes.
    Utilizing an aseptic technique the existing catheter was injected with contrast and images obtained. Over a wire the catheter was removed and an 8-French 22 cm internal only double pigtail ureteral stent was placed. One pigtail portion was in the bladder. Second portion was in the pelvis extending in to lower calyx. External access was removed. Patient tolerated the procedure well.
    IMPRESSIO
    1. Successful placement of an internal only ureteral stent, external access was removed.

    2.Ureteral stnt could be left in place for 6-8 weeks and removed at that time.

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by elamathi View Post
    Hi all,

    Pls clarify the codes for the procedure performed.

    INFORMATION:
    Internal/externa nephroureteral stent in place, patient had urinoma and ureteral injury, nephroureteral i place approximately one week.
    Consent was obtained. 1% lidocaine utilized as local anesthesia. Divided doses of ed and fentanyl were utilized for conscious sedation. The patient's cardiovascular ored. Procedure time was less than 30 minutes.
    Utilizing an aseptic technique the existing catheter was injected with contrast and images obtained. Over a wire the catheter was removed and an 8-French 22 cm internal only double pigtail ureteral stent was placed. One pigtail portion was in the bladder. Second portion was in the pelvis extending in to lower calyx. External access was removed. Patient tolerated the procedure well.
    IMPRESSIO
    1. Successful placement of an internal only ureteral stent, external access was removed.

    2.Ureteral stnt could be left in place for 6-8 weeks and removed at that time.
    "Internal/externa nephroureteral stent in place, patient had urinoma and ureteral injury, nephroureteral i place approximately one week"
    If this procedure was coded 50392/74475 then the second procedure (based on the above note) would be
    50393/74480
    50394/74425

    If the first procedure was coded 50393/74480 then the above note would be
    50398/74480
    50394/74425

    I hope this helps.
    Danny L. Peoples
    CIRCC,CPC

  3. Default
    Hi,

    Do we need any interpretation to code 50394/74425. Here the documentation states contrast was injected in the catheter and imaged. Is this ok to code 50394/74425 or else we have to code 50393/74480 alone. Right!

  4. Default
    I was told at an RBMA coding seminar that a nephroureteral to ureteral stent exchange would be 50387.

    In order to bill for 50394/74425 a true nephrostogram must have been done. Often times contrast is injected just for roadmapping. If you don't have an interp, a nephrostogram wasn't done.

    Diane Huston, CPC,RCC

  5. #5
    Location
    Birmingham, Alabama
    Posts
    889
    Smile oops
    Quote Originally Posted by dhuston View Post
    I was told at an RBMA coding seminar that a nephroureteral to ureteral stent exchange would be 50387.

    In order to bill for 50394/74425 a true nephrostogram must have been done. Often times contrast is injected just for roadmapping. If you don't have an interp, a nephrostogram wasn't done.

    Diane Huston, CPC,RCC
    Diane is correct on both accounts. I made the error of assuming with the first injection, and I completely missed the internal/external wording in the note.

    In my defense, I do not code these often.
    Danny L. Peoples
    CIRCC,CPC

  6. Default
    Hi,


    How will you code when a nephrostomy catheter was removed using contrast injection(no interpretation) and the ureteral stent was placed through same access. Is this should be coded as 50398 or 50393. . Clarify the codes..

    Thanks
    Elamathi

  7. Default
    I will code it as 50393

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