Good Morning Everyone.

Please read the report below. One coder coded it 50393, 74480. Part of me thinks it should be an unlisted code as we are placing wires around the calix. Thanks!

TECHNIQUE: The patient was placed supine and prepped and draped in the usual
sterile fashion. General anesthesia administered. Access to the calix containing
the large stone was selected with fluoroscopy. 22 gauge needle advanced. 0.018
wire advanced. Transitional dilator advanced. At this time, the transitional
dilator was injected, demonstrating filling about the patient's calculus, and a
small infundibulum leading to the renal pelvis. Access was lost while attempting
to select this infundibulum with a wire. Consequently, a 22 gauge needle was
again advanced along the stone. 0.018 wire advanced. Renal pelvis selected.
Transitional dilator advanced. 0.035 Glide Wire was advanced. 5 French Kumpe
catheter advanced and used to select the bladder. Using the Kumpe catheter, the
Glide Wire was exchanged for a 0.035 Amplatz Extra Stiff Wire. 7 French fascial
dilator advanced. 6 French sheath advanced into the left proximal ureter. A
second Extra Stiff Wire was advanced. Using the Kumpe catheter, this second wire
was advanced into the bladder.
Final image demonstrates positioning of the wires and catheter along the calix
containing the large stone, with both wires present within the bladder for
access for percutaneous nephrolithotomy.
1. Successful access obtained to the calix of interest.
2. Successful placement of nephroureteral access catheter.