# PCNL Help!!



## lcole7465 (Sep 4, 2017)

I'm new to Urology and in need of input on the following op report: 
It has been coded: 50081, 52332-RT, 52005-RT
I don't see any edits for these codes, except for 52005 & 52332. From what I'm reading on 50081 most of this is included in the code. Therefore, I believe it should only be the 50081.

Procedure(s):* Cysto removal of right stent insertion of right occlusion balloon catheter on right
PERCUTANEOUS NEPHROLITHOTOMY, RIGHT URETERAL STENT INSERTION, RIGHT NEPHROSTOGRAM, RIGHT NEPHROSTOMY TUBE INSERTION

Indications:* Patient has a 4 x 2 cm right renal pelvis stone as well as a 12 mm right lower pole stone patient presents for percutaneous nephro lithotripsy of same she has had a stent placed already.
Details of Procedure:* Patient was 1st placed in dorsolithotomy position in the cystoscopy suite cysto was performed with a 22 French scope the stent was identified grasped and removed partially while threading up in 035 wire subsequently a ureteral occlusion balloon catheter was then inserted over a wire and fluoroscopically confirmed to be in good position Foley catheter was inserted and secured to the occlusion balloon catheter thereafter the patient was then transferred to the interventional radiology suite.* Where Dr. Kasza placed a right percutaneous inter cath into the right kidney.* I was there for this part of the procedure and removed the occlusion balloon catheter in the cath lab.

Patient was then brought up to the OR suite and was given general endotracheal anesthesia on the stretcher she was then rotated into the prone position making sure that there are axillary and pelvic pads as well as pads under her ankles as well.* The dressing was removed from the intra catheterization 6 French catheter in the right flank it was sterilely prepped and draped.* Subsequently the patient was did it did head is a 035 for amplitudes superstiff wire inserted in fluoroscopic confirmed to go in the bladder there after an 810 dilator was passed over this and a 2nd Sensor wire was then passed into the bladder as well thereafter at an incision was made in the right flank with 10 scalpel blade of approximately 2 cm thereafter the NephroMax balloon dilator was then inserted and fluoroscopically confirmed to correlate over the lower pole infundibulum where it enters the renal pelvis with a large stone was.* Subsequently was dilated to 16 atmospheres pressure and held for 3 minutes.* Thereafter the sheath was advanced over the balloon and the balloon deflated.* The nephroscope was then inserted and the stone was identified in the renal pelvis.* The lithoclast unit was used however the ultrasound component did not function.* In light of this the case was done purely with the pneumatic device and lithotripsy was started at approximately 10:15 a.m. and proceeded for add an hour and 15 minutes.* Throughout the procedure the stone was manipulated and the pieces were grasped and removed as necessary as well as suction through the suction canister the patient also had a lower pole stone of 12 mm that need to be addressed as well.* After removing approximately a 3rd of the stone the stone was able to be manipulated and rotated into position to allow further lithotripsy of this same.* The patient had further lithotripsy performed of the remaining 2/3 and this was also removed after an hour of lithotripsy.* The lower pole stone was able be identified in its entirety and sent as a separate specimen.* Thereafter retrograde extremity thereafter a nephrostogram was performed which showed no extravasation and nose some significant filling defects.* Fluoroscopy without of contrast identified no residual stones as well.* At this point a 6 x 24 contour double-J stent was then inserted in an antegrade fashion through the nephrostomy site down the right ureter.* It was noted to coil in the bladder and then the wire removed and coiled proximally in the renal pelvis.* Subsequently a 20 French Mallinckrodt catheter was then introduced into the renal pelvis and the stylette was removed to deploy the mL cot.* Thereafter of nephrostogram again showed it to be in excellent position.* The remaining safety wire was removed under fluoroscopy in both stent and nephrostomy tube were in good position. Subsequently the nephrostomy tube was sewn in place with 2 Ethilon in a interrupted vertical mattresses.* Sterile dressing was applied.* And Foley catheter was draining blood-stained urine.* The occlusion catheter had been already removed.* Patient was transferred cover room satisfactory condition.


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## cgaston (Sep 5, 2017)

It looks like 52356 to me


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## LMCODER (Sep 7, 2017)

50080 nephrostolithotomy up to 2cm.
50040  nephrostomy tube 
50695 xs ureteral stent 
52310 xs  cysto with stent removal 
74485  26 S&I for dilation


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## Brooke_cale (Sep 7, 2017)

I disagree with the answer of 50080. This stone was 4x2 cm. This clearly shows a 50081. And if you read the PCNL descriptions, they state that it can be snared, litho'd etc, so it is NOT a 52353


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## LMCODER (Oct 2, 2017)

Sorry that was an over site on my part the first code is 50081


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## Ritika (Oct 4, 2017)

*PCNL Help*

Hi, I think it should be coded as 50081 for PCNL, 52332 for ureteral stent and 50432 for nephrostomy tube insertion which includes the nephrostogram.


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## LMCODER (Oct 10, 2017)

The stent was inserted antegrade so it cannot be 52332 . Also at the end of the procedure he inserts a nephrostomy tube for drainage and the correct code is 50040 .


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## debbiesom (Nov 8, 2017)

*Pcnl*

I have reviewed this with Dr Michael Ferragomo in the past. Our Urology practice keep him on retainer as our consultant. 

Stenting, fragmentation, dilation, basket extraction are included in 50080 or 50081 (PCNL)
Placement of Nephrostomy Tube (New) is done percutaneous so code is 50432  If it is an exchange of nephrostomy tube code is 50435  this includes nephrostogram & reading (50430 or 50431 included)
If he does a Renal Access code 50395 with 50432-XU 
If he uses a Cystoscope to remove the stent then yes 52310 or to place the stent with cystoscope 52332 but usually the stent is antegrade (from the top)
To remove Nephrostomy tube from the flank 50389

Debbie
CPC, CUC


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