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nephrostomy

  1. Default nephrostomy
    Medical Coding Books
    Can we code the following procedure with 50688 & 75984? Do anyone have any other suggestions?

    History: Patient is an 80-year-old male with bladder cancer and
    urinary diversion through a ileal loop, left ureteral stricture
    status post placement of a reverse left nephrostomy tube through
    the stoma into the left renal collecting system referred for
    routine catheter exchange.

    Approach: Retrograde access through the stoma

    Procedure: Continuous physiological monitoring was carried out
    throughout the procedure. With the patient in the supine position
    the stoma was prepped and draped in the usual sterile fashion.
    The indwelling nephrostomy tube is noted to have retracted into
    the stoma. It was retrieved under fluoroscopic guidance using a
    clamp. A catheter nephrostogram was performed. Under fluoroscopic
    guidance the indwelling catheter was removed over a stiff
    guidewire and a new 10 French pigtail self retaining
    nephroureteral stent was placed with its distal tip in the renal
    pelvis and proximal loop formed within the ileal loop. Aspirated
    urine was clear. A completion nephrostogram was performed. The
    catheter was left to gravity drainage within the bag. The
    patient tolerated the procedure without incident.

    Findings: The nephrostogram demonstrated minimal hydronephrosis
    with little visualization of the left ureter. There is flow of
    contrast down the catheter into the ileal loop.

    Conclusion: Fluoroscopically guided replacement of a left 10
    French reverse nephrostomy catheter for a new 10-French by 24-cm
    left reverse nephroureteral stent with its distal tip within the
    renal pelvis and proximal loop within the ileal loop. The stent
    exits the stoma to be placed to bag drainage within the ostomy
    drainage bag.
    Last edited by prabha; 08-07-2009 at 04:26 AM.
    Prabha CPC

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by prabha View Post
    Can we code the following procedure with 50688 & 75984? Do anyone have any other suggestions?

    History: Patient is an 80-year-old male with bladder cancer and
    urinary diversion through a ileal loop, left ureteral stricture
    status post placement of a reverse left nephrostomy tube through
    the stoma into the left renal collecting system referred for
    routine catheter exchange.

    Approach: Retrograde access through the stoma

    Procedure: Continuous physiological monitoring was carried out
    throughout the procedure. With the patient in the supine position
    the stoma was prepped and draped in the usual sterile fashion.
    The indwelling nephrostomy tube is noted to have retracted into
    the stoma. It was retrieved under fluoroscopic guidance using a
    clamp. A catheter nephrostogram was performed. Under fluoroscopic
    guidance the indwelling catheter was removed over a stiff
    guidewire and a new 10 French pigtail self retaining
    nephroureteral stent was placed with its distal tip in the renal
    pelvis and proximal loop formed within the ileal loop. Aspirated
    urine was clear. A completion nephrostogram was performed. The
    catheter was left to gravity drainage within the bag. The
    patient tolerated the procedure without incident.

    Findings: The nephrostogram demonstrated minimal hydronephrosis
    with little visualization of the left ureter. There is flow of
    contrast down the catheter into the ileal loop.

    Conclusion: Fluoroscopically guided replacement of a left 10
    French reverse nephrostomy catheter for a new 10-French by 24-cm
    left reverse nephroureteral stent with its distal tip within the
    renal pelvis and proximal loop within the ileal loop. The stent
    exits the stoma to be placed to bag drainage within the ostomy
    drainage bag.

    I agree with your code selection. 50688/75984

    HTH
    Danny L. Peoples
    CIRCC,CPC

  3. Default Nephrostomy
    Do we need to code catheter nephrostogram with this?
    Prabha CPC

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