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Renal Cyst Drainage

  1. #1
    Default Renal Cyst Drainage
    Medical Coding Books
    Its a long report but I hope someone can help.

    My manager came up with 50392, 50390-59, 770012, 99144, 99145x2
    but I dont know how.

    Clinical History: Large left renal cyst resulting in compression of the left ureter and resultant hydronephrosis. Request is for CT guided cyst 3 The procedure was discussed with patient's caregivers in family as well as the patient. Consent was obtained. Patient's prior imaging studies have been reviewed. Patient was placed a CT examination table in supine position. Localization imaging was performed. The 15 cm simple cyst arising from the anterior interpolar region of the left kidney is identified. The skin of the lateral aspect of the left abdomen was prepped and draped in sterile fashion. Monitored conscious sedation was administered for 1 hour. Following local anesthesia, a sheath needle was advanced into the left renal cyst or a percutaneous approach the lateral left abdomen. Clear cyst fluid was aspirated, a specimen of which was sent for microbiologic analysis. Next, the sheath needle was exchanged over guidewire for an 8 French locking loop all-purpose drainage catheter. This was placed a vacuum bottle suction and a total of approximately 1200 ml of cyst fluid aspirated. Repeat imaging was performed. This showed complete decompression of the cyst. Next, 60 cc of concentrated nonionic contrast was injected into the drainage catheter. Repeat imaging was performed. Also 10 minutes delayed images were obtained. This was performed to assess the possibility of communication of this cyst with the renal collecting system. A small amount of residual contrast is noted within the renal collecting system prior to the procedure. Therefore Hounsfield units of the collecting system were measured both prior to and following the instillation of the contrast into the cyst cavity. The delayed images showed no increase in Hounsfield units of the urine within the renal collecting system to suggest passage of the concentrated contrast into the renal collecting system. Therefore, the contrast was aspirated from the cavity and a total of 50 ml of dehydrated ethanol injected into the cyst cavity. This was allowed to dwell for a total of 30 minutes. The patient was rotated in position every 5 to 10 minutes to insure contact with all walls of this cyst with the sclerosing agent. The ethanol was then aspirated from the drainage catheter. All 50 ml of ethanol was recovered. Repeat imaging was performed. Again this demonstrated complete decompression of the cyst. Therefore the drainage catheter was removed. Sterile dressing was applied the entry site. Patient tolerated the procedure well. No complication was encountered.


    IMPRESSION:
    Uneventful drainage a large left renal cyst followed by ethanol sclerosis.

  2. #2
    Location
    Birmingham, Alabama
    Posts
    890
    Default
    Quote Originally Posted by drobinson1 View Post
    Its a long report but I hope someone can help.

    My manager came up with 50392, 50390-59, 770012, 99144, 99145x2
    but I dont know how.

    Clinical History: Large left renal cyst resulting in compression of the left ureter and resultant hydronephrosis. Request is for CT guided cyst 3 The procedure was discussed with patient's caregivers in family as well as the patient. Consent was obtained. Patient's prior imaging studies have been reviewed. Patient was placed a CT examination table in supine position. Localization imaging was performed. The 15 cm simple cyst arising from the anterior interpolar region of the left kidney is identified. The skin of the lateral aspect of the left abdomen was prepped and draped in sterile fashion. Monitored conscious sedation was administered for 1 hour. Following local anesthesia, a sheath needle was advanced into the left renal cyst or a percutaneous approach the lateral left abdomen. Clear cyst fluid was aspirated, a specimen of which was sent for microbiologic analysis. Next, the sheath needle was exchanged over guidewire for an 8 French locking loop all-purpose drainage catheter. This was placed a vacuum bottle suction and a total of approximately 1200 ml of cyst fluid aspirated. Repeat imaging was performed. This showed complete decompression of the cyst. Next, 60 cc of concentrated nonionic contrast was injected into the drainage catheter. Repeat imaging was performed. Also 10 minutes delayed images were obtained. This was performed to assess the possibility of communication of this cyst with the renal collecting system. A small amount of residual contrast is noted within the renal collecting system prior to the procedure. Therefore Hounsfield units of the collecting system were measured both prior to and following the instillation of the contrast into the cyst cavity. The delayed images showed no increase in Hounsfield units of the urine within the renal collecting system to suggest passage of the concentrated contrast into the renal collecting system. Therefore, the contrast was aspirated from the cavity and a total of 50 ml of dehydrated ethanol injected into the cyst cavity. This was allowed to dwell for a total of 30 minutes. The patient was rotated in position every 5 to 10 minutes to insure contact with all walls of this cyst with the sclerosing agent. The ethanol was then aspirated from the drainage catheter. All 50 ml of ethanol was recovered. Repeat imaging was performed. Again this demonstrated complete decompression of the cyst. Therefore the drainage catheter was removed. Sterile dressing was applied the entry site. Patient tolerated the procedure well. No complication was encountered.


    IMPRESSION:
    Uneventful drainage a large left renal cyst followed by ethanol sclerosis.
    I would take a look at the codes for renal abscess drainage:

    50021 Percutaneous drainage of perirenal or renal abscess (includes sedation)
    75989 Radiological guidance for percutaneous drainage with catheter; supervision and interpretation.

    I do not agree with the 50390,50392,77012 in this scenario.

    HTH
    Last edited by dpeoples; 07-21-2009 at 01:44 PM.
    Danny L. Peoples
    CIRCC,CPC

  3. Default Renal Cyst
    I don't agree with either coding scenarios. First of all, I wouldn't use the abscess codes, as these codes are for a drainage catheter left in and sutured to the skin, and according to your report, the catheter was NOT left it. Also, code 50392 also specifies that the catheter is left in.

    I would charge the 50390/77012 for the cyst draining. I haven't run across the sclerosing agent, but I would use 20500/76080 for the injection of that, and then your sedation codes.

    Hope that helps.

    Patti Downing, RCC

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