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Placement of access

  1. Default Placement of access
    Medical Coding Books
    Can anyone help w/ the following?

    Conscious sedation, Antegrade left nephrostogram (I got this) but need help with placement of access for endourology procedure.

    Interventional radiologist dictates;

    Difinitive entrance point namely a posterior inferior calyx was selected for puncture. The area was infiltrated w/ 1% lidocaine. A 3mm dermatotomy was made. An 18-guage Chiba needle was advanced under continuous fluoroscopic guidance using triangulation technique in order to puncture a posterior calyx. A glidewire was advanced, the needle was exchanged for a 4 French glide cath which was advanced distally across the midline into the patient's ileal conduit. Glidewire was removed and an Amplatz superstiff wire was advanced. The cath was removed and the Amplatz wire was taped to the body wall.

    I coded so far, 99144, 50394, 74425-26, 77002-26 for the Conscious sedation and antegrade left nephrostogram, any help with the rest will be greatly appreciated!

  2. #2
    Thumbs up Urology.
    Quote Originally Posted by armymomryan View Post
    Can anyone help w/ the following?

    Conscious sedation, Antegrade left nephrostogram (I got this) but need help with placement of access for endourology procedure.

    Interventional radiologist dictates;

    Difinitive entrance point namely a posterior inferior calyx was selected for puncture. The area was infiltrated w/ 1% lidocaine. A 3mm dermatotomy was made. An 18-guage Chiba needle was advanced under continuous fluoroscopic guidance using triangulation technique in order to puncture a posterior calyx. A glidewire was advanced, the needle was exchanged for a 4 French glide cath which was advanced distally across the midline into the patient's ileal conduit. Glidewire was removed and an Amplatz superstiff wire was advanced. The cath was removed and the Amplatz wire was taped to the body wall.

    I coded so far, 99144, 50394, 74425-26, 77002-26 for the Conscious sedation and antegrade left nephrostogram, any help with the rest will be greatly appreciated!
    CPT codes should be 50384, 77002-26, 59

  3. Default
    Thank you !!!

  4. #4
    Location
    Alexandria, LA
    Posts
    518
    Default
    Quote Originally Posted by drspatil View Post
    CPT codes should be 50384, 77002-26, 59
    Can you tell me where you got 50384 from this? There was no indwelling catheter. They placed a cath temporarily to help with this access and then removed it when they had the amplatz wire in place, but I do not see an indwelling ureteral catheter removal?
    Sounds like this is 50395 except there was no dilation.
    I'm assuming there is more to the report since there is no conscious sedation or nephrostogram in this portion of the report.

    And what is 77002-26-59 being used for? 50384, even if correct, includes guidance.

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