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Live Donor Renal Transplant

  1. #1
    Default Live Donor Renal Transplant
    Medical Coding Books
    If anyone could code this procedure properly I would greatly appreciated it. I have never coded for any type of transplant and found this to be difficult. This is what I came up with: 50320RT,50325, 50327 LT, 50328 LT, 50329 LT, 50365LT. Also if there is any resources I can be directed to for additional information on renal transplants that would also be much appreciated. Thank you.

    Procedure:
    On the day of surgery, the patient was brought to the operating suite approximately one hour following the start of his donor's procedure. A general endotracheal anesthetic was administered. At this point, the Foley catheter was then placed sterilely filling the bladder with approximately 150 mL of methylene blue tinted BAN solution. We then prepped and draped the abdomen in the usual sterile fashion. Upon preparation of the abdomen, we noted a right inguinal incision almost certainly from a right inguinal hernia repair. This was not part of his medical history and was unnoticed on phsical exam due to hair patterns as well as the very fine line from scarring which this incision had rendered. At this point, we decided rather than placing the kidney in the right iliac fossa would switch to the left iliac fossa site. A left lower transverse abdominal incision was made approximately 19 cm in length. Electrocautery was used to divide the soft tissues down to the retroperitoneal space. The external iliac artery and vein were then indentified and mobilized. The artery was carefully mobilized laterally using a red rubber catheter as well.
    At this point, I walked across the hall to the donor's operative suite and collected the kidney on the back table, placed the kidney in a basin that had been filled with crushed ice and covered with a Lahey bag. At this point, the stapled end of the renal vein was excised and using an Angiocath attached to tubing we then flushed the renal allograft with approximately 400 mL of custodial solution completely exsanguinating the kidney. The kidney was then covered sterilely and brought to the recipient room and on the back table we carefully cleaned all excess connective tissue and fat from the capsule. The single artery was identified and carefully mobilized back to near hilar region and checked for leaks. None were identified. We then also carefully mobilized and cleaned the renal vein back to near hilar region also and checked for any leaks. There was a small branch that we identified as leaking and we oversewed this with a 5-0 Prolene suture. The ureter was identified and carefully cleaned of any excess tissue, taking care not to damage the blood supply. The kidney was then adequately prepared for transplantation.
    We then turned our attention back to the operative site. A Satinsky clamp was placed across the external iliac vein. A venotomy was made using an 11 blade and Potts scissors. A 5-0 Prolene suture was then placed in each corner and tagged. The kidney was then brought to the field and a running anastomosis was created between the renal vein and the external iliac vein using 5-0 Prolene. At this point, vascular clamps were placed proximally and distally on the external iliac artery creating a hemostatic segment. At this point, an arteriotomy was made using an 11 blade and enlarged using a coronary punch. We then anastomosed the renal artery to the external iliac artery using 6-0 Prolene suture in a running manner. The warm ischemic time for this anastomosis should be 30 minutes. The scope cold ischemic time should be approximately 25 minutes. The kidney perfused beautifully and started making urine immediately. We paid special attention to the positioning of the renal artery and vein as these were slightly crossed due to the right-sided nature of this renal allograft being placed on the left side; however, this did not pose any concern as the vessels were widely patent and the artery was not obstructing in any manner or lying across the vein so that there was no concern for kinking of the vein. We then identified the spermatic cord, careflly brought the ureter behind that. We shortened the ureter back to a bleeding segment and spatulated this. The dome of the bladder was then opened using electrocautery. We then carefully anastomosed the spatulated ureter to the bladder using 6-0 suture. We did use a 5 French pediatric feeding tube as a temporary stent during the anastomosis. This was removed prior to completion of the anastomosis.
    Upon completion of this ureteral anastomosis, we checked for any leaks using peanuts and none were found. The wound was found to be hemostatic and we closed the fascia using 0 POS suture in a running manner and the subcutaneous tissue and skin were closed using 3-0 Vicryl and 4-0 Monocryl in a running manner.

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by MSOATES View Post
    If anyone could code this procedure properly I would greatly appreciated it. I have never coded for any type of transplant and found this to be difficult. This is what I came up with: 50320RT,50325, 50327 LT, 50328 LT, 50329 LT, 50365LT. Also if there is any resources I can be directed to for additional information on renal transplants that would also be much appreciated. Thank you.

    Procedure:
    On the day of surgery, the patient was brought to the operating suite approximately one hour following the start of his donor's procedure. A general endotracheal anesthetic was administered. At this point, the Foley catheter was then placed sterilely filling the bladder with approximately 150 mL of methylene blue tinted BAN solution. We then prepped and draped the abdomen in the usual sterile fashion. Upon preparation of the abdomen, we noted a right inguinal incision almost certainly from a right inguinal hernia repair. This was not part of his medical history and was unnoticed on phsical exam due to hair patterns as well as the very fine line from scarring which this incision had rendered. At this point, we decided rather than placing the kidney in the right iliac fossa would switch to the left iliac fossa site. A left lower transverse abdominal incision was made approximately 19 cm in length. Electrocautery was used to divide the soft tissues down to the retroperitoneal space. The external iliac artery and vein were then indentified and mobilized. The artery was carefully mobilized laterally using a red rubber catheter as well.
    At this point, I walked across the hall to the donor's operative suite and collected the kidney on the back table, placed the kidney in a basin that had been filled with crushed ice and covered with a Lahey bag. At this point, the stapled end of the renal vein was excised and using an Angiocath attached to tubing we then flushed the renal allograft with approximately 400 mL of custodial solution completely exsanguinating the kidney. The kidney was then covered sterilely and brought to the recipient room and on the back table we carefully cleaned all excess connective tissue and fat from the capsule. The single artery was identified and carefully mobilized back to near hilar region and checked for leaks. None were identified. We then also carefully mobilized and cleaned the renal vein back to near hilar region also and checked for any leaks. There was a small branch that we identified as leaking and we oversewed this with a 5-0 Prolene suture. The ureter was identified and carefully cleaned of any excess tissue, taking care not to damage the blood supply. The kidney was then adequately prepared for transplantation.
    We then turned our attention back to the operative site. A Satinsky clamp was placed across the external iliac vein. A venotomy was made using an 11 blade and Potts scissors. A 5-0 Prolene suture was then placed in each corner and tagged. The kidney was then brought to the field and a running anastomosis was created between the renal vein and the external iliac vein using 5-0 Prolene. At this point, vascular clamps were placed proximally and distally on the external iliac artery creating a hemostatic segment. At this point, an arteriotomy was made using an 11 blade and enlarged using a coronary punch. We then anastomosed the renal artery to the external iliac artery using 6-0 Prolene suture in a running manner. The warm ischemic time for this anastomosis should be 30 minutes. The scope cold ischemic time should be approximately 25 minutes. The kidney perfused beautifully and started making urine immediately. We paid special attention to the positioning of the renal artery and vein as these were slightly crossed due to the right-sided nature of this renal allograft being placed on the left side; however, this did not pose any concern as the vessels were widely patent and the artery was not obstructing in any manner or lying across the vein so that there was no concern for kinking of the vein. We then identified the spermatic cord, careflly brought the ureter behind that. We shortened the ureter back to a bleeding segment and spatulated this. The dome of the bladder was then opened using electrocautery. We then carefully anastomosed the spatulated ureter to the bladder using 6-0 suture. We did use a 5 French pediatric feeding tube as a temporary stent during the anastomosis. This was removed prior to completion of the anastomosis.
    Upon completion of this ureteral anastomosis, we checked for any leaks using peanuts and none were found. The wound was found to be hemostatic and we closed the fascia using 0 POS suture in a running manner and the subcutaneous tissue and skin were closed using 3-0 Vicryl and 4-0 Monocryl in a running manner.
    The first thing I can see is that you don't need to code the 50320 because this op report does not show the obtaining of the donor kidney. Another surgeon probably did that part of the procedure. Your doctor did the transplant of the donor kidney into the recipient which is 50360 and it is a unilateral code so you do not need to indicate Rt or LT. You would also code the 50325 for the backbench work on prepping the donor kidney for transplant. I found all this information on the Encoder Pro which had descriptions of the procedures and I compare them to the op report.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Default
    Thank you. So, the anastomoses of the artery, vein and ureter are all inclusive of 50360?

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by MSOATES View Post
    Thank you. So, the anastomoses of the artery, vein and ureter are all inclusive of 50360?
    They are part of the procedure.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. #5
    Default
    Got it! Thank you so much for your help, Arlene....I really appreciate it.

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