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Thread: Nephrostomy tube

  1. #1

    Default Nephrostomy tube

    AAPC: Back to School
    Can anybody suggest me how to coded this senario, i have coded only 50387 is some other code will come.
    69 year old male with calculus in the right
    renal pelvis. Patient status post right percutaneous nephrostomy
    placement. Request made for ureteral stent placement.

    Procedure: Initially the procedure was explained to the patient
    including risks, benefits and alternatives. The risks discussed
    included but were not limited to bleeding, infection, renal or
    ureteral injury. The patient understood, asked appropriate
    questions and signed informed consent. 15.0 minutes flouroscopy
    time. 20cc ultravist 300 used as contrast. The patient received
    IV versed and fentanyl, administered and monitored by the
    interventional radiology nurse.

    The patient was placed prone on the angiography table. The right
    flank and external portion of the nephrostomy tube was prepped and
    drapped in the usual sterile fashion. Scout film demonstrates the
    catheter with pigtail formed in the right flank. Contrast was
    injected confirming the catheter to be in proper position within
    the right renal pelvis. The there is abrupt cutoff at the right
    ureteropelvic junction with little contrast flowing into the
    ureter. An Amplatz wire was advanced through the nephrostomy and
    exchange was made for a 7 French sheath. Contrast injection
    demonstrates positioning of the sheath within the renal pelvis.
    Using a stiff glide wire a Berenstein catheter was advanced into
    the urinary bladder. Contrast was an injected, confirming
    positioning within the urinary bladder. Exchange was then made for
    an Amplatz wire. An 8 French by 26 cm long ureteral stent was
    then advanced over the Amplatz. A loop was formed in the urinary
    bladder and renal pelvis. An 8 French all purpose drainage
    catheter was then advanced into the renal pelvis. The pigtail was
    formed and locked. Contrast was injected through nephrostomy
    demonstrating opacification of the renal pelvis and flow through
    the ureteral stent. The nephrostomy was secured to the skin with
    3-0 prolene and a sterile dressing was applied.

    The nephrostomy was left to gravity bag drainage. The patient was
    instructed to cap the nephrostomy when the urine became clear. He
    was also instructed to the place the nephrostomy back to gravity
    bag drainage if he developed fever, pain or leakage around the

    The patient tolerated the procedure well. No immediate

    Impression: Successful placement of 8 French by 26 cm long right
    ureteral stent. A covering 8 Fr nephrostomy was left in place.

  2. #2


    it sounds like this was a conversion of a perc. neph. to a nephroureteral stent...74425/50394, 74480/50393, and it sounds like the neph. tube was changed?? (75984/50398)
    I'm looking at the Interventional Radiology Users' guide and this is how they're describing this procedure..."Conversion of a percutaneous nephrostomy to a nephroureteral stent"
    It also mentions this:
    "There is no operative code for a change of catheter since this is inherent in placing the nephroureteral stent. However, if the procedure performed was instead placement of a double pigtail stent with the nephrostomy left in place, the code for a change of catheter 50398 would be added, as code 50393 only describes placement of the stent."

  3. #3


    I can get u, i think ur point of view is correct. How about code 50387 please explain me.
    Last edited by Shirleybala; 08-17-2008 at 11:12 PM.

  4. #4


    50387 is a nephroureteral stent change...meaning there was an NUS there, they removed it, and replaced it with another NUS. This case there was a nephrostomy tube there that was converted into an NUS tube.

  5. #5
    Join Date
    Apr 2007


    We can code 50394,74425-26,50393,74480,50398-59,75984 since injection through nephrostomy was performed and stent was placed and nephrostomy catheter was placed for supportive purpose for the stent we considered this as exchange,coming to use of code 50387 it is only applicable when stent were replaced with stent.not for tube replacement with stent

  6. #6


    I agree

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