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nephroureterostomy to nephrostomy

  1. Default nephroureterostomy to nephrostomy
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    Does the below procedure is performed through ileostomy and can we code this as 50688 & 50684??

    Clinical history: Patient is a 83-year-old female with a history
    of bladder cancer s/p radical resection and ileal conduit who had
    a percutaneous nephroureterostomy placed 07/20/2010 due to
    moderate left hydronephrosis. Request for conversion of
    percutaneous nephroureterostomy to upside down nephrostomy.

    Procedure: Nephrostogram
    Exchange of nephroureterostomy for upside down nephrostomy
    fluoroscopy time 3.1 minutes.
    The patient was placed on the angiography table in a right lateral
    position. The left flank and the external portion of existing
    nephroureterostomy were double prepped and draped in the usual
    sterile fashion. The ostomy site was also prepped and draped with
    sterile towels.
    Preliminary scout demonstrates a catheter with pigtail formed in
    the flank and pelvis. Contrast was injected through the existing
    nephroureterostomy demonstrating proper positioning. Under
    fluoroscopic guidance, a stiff guidewire was advanced through the
    catheter and exchange was made for a 7 French sheath. Contrast was
    injected confirming position with in the renal collecting system.
    A 4 French Berenstein catheter was advanced over the guidewire
    into the ileal conduit. A Glidewire was then used to advance the
    catheter out the ostomy. An Amplatz wire was then advanced into
    the renal pelvis. Exchange was then made for an 8.5 French, 45 cm
    long all-purpose drainage catheter. Contrast was then injected via
    the catheter to confirm position. A sterile dressing was applied.
    The ostomy bag was replaced and the drainage catheter was noted to
    be successfully draining into the ostomy bag.

    The patient tolerated the procedure well and left the department
    in stable condition; no immediate complications.

    Impression: Successful conversion of percutaneous
    nephroureterostomy to 8.5F, 45cm long upside-down nephrostomy.
    Prabha CPC

  2. Default
    Usually the stage 2 consisted of converting the antegrade catheter to a retrograde nephroureteral stent by directing the distal end of the wire out of the stoma with a Berenstein catheter. This allowed retrograde advancement of an 8.5- or 10.2-French, 40- to 50-cm locking-loop catheter (Ultrathane Multipurpose Drainage Catheter, Cook) through the ileal conduit positioned with the pigtail in the renal pelvis and the catheter hub in the stoma bag for drainage.
    The answer to your question is : yes . as per my perception.
    and 74425

    But double confirm with your Physician whether it is the same procedure he did.
    Last edited by preserene; 08-19-2010 at 09:56 PM.

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