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Thread: Lost --please help with CPTs

  1. #1

    Default Lost --please help with CPTs

    AAPC: Back to School
    Looking at 50400, 50040 and 52332

    Procedure: dismembered pyeloplasty with right nephrostomy and place of double-J stent.

    Op note reads: a right flank incision was made over the tip of the twelth rib and carried anteriorly through the three layers of muscle opening the retroperitoneum. The kidney was dissected from the right psoas muscle area and the right ureter was placed around a flexible rubber tube and dissection of the entire kidney and renal pelvis and ureteropelvic junction was carried out to identify the anatomy. Stay sutures were placed above the UPJ lateral to the UPJ and inferior to the UPJ. The ureter was transected at the ureteropelvic junction and spatulated on the antimesenteric border. The renal pelvis was opened and the redundant portions of the pelvis excised and sent to pathology. The segment of the ureteral pelvic junction was sent to pathology. A careful inspection of the interior of the kidney with ureteral irrigation of all the calyces produced no stone. One could not feel a stone or see a stone. The stone was not found in the kidney bed after sufficient irrigation. It is felt that the stone is probably trapped within an unclosed calyx and it was not worth doing an aggressive dissection to remove this asymptomatic stone. The right ureter was intubated with a guidewire and a 6-French Kwart double-J stent with the string removed. The lower end of the string removed. The lower end of the stent was placed into the bladder. The upper end was curled up in the renal pelvis.
    A nephrostomy tube was placed in the lower dependent portion of the kidney placing a right-angle clamp through the lower pole calyx and exiting the lower pole of the kidney. An 19-French Foley catheter was grasped by the right angle and pulled into the renal pelvis. The tip of the Foley catheter was removed. 1.5 mL was placed into the balloon to secure it in place. A 3-0 chromic suture was placed in a horizontal mattress fashion surrounding the nephrostomy tube to secure it in good position.
    The dismembered pyeloplasty was performed with 4-0 chromic catgut closing the resected portion of the renal pelvis and the spatulated ureter was sutured with interrupted 4-0 chromic suture to the dependent portion stab wound in the skin below the incision for a good drainage of the kidney.
    The nephrostomy tube was sutured in place with 3-0 silk, suture.
    The right flank was irrigated with warm saline and all bleeding was well-controlled.
    The right flank incision was closed in three layers with interrupted and running #1 PDS suture. The wound was irrigated with neomycin and Bacitracin and the skin was closed with titanium staples. Sponge and needle count was correct by the nurse in charge.

  2. #2
    Join Date
    Apr 2007
    Lubbock, TX


    52332 is done with a scope - I didn't see that in the OP report, but I could have just missed it...

    Did you check out 50405? I didn't know if he was describing a calycoplasty or not, but if he wasn't, I'd probably go with 50400. You might find this helpful:

  3. #3
    Join Date
    Apr 2007
    Lubbock, TX

    Default This is random but...

    If you're coding a lot of urology, you might like this - I think I'm going to print it out just in case I ever need it:

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