# Nephostogram



## pharmon (Dec 12, 2008)

This one has had me baffled a few days.  I've worked it and laid it down, worked on it some more, and today I hope someone can just check behind me.  I am sorry its lengthy.  I feel I'm overlooking something.  Thanks.  

The flanks are prepped & drapped in a sterile fashion.  The previously placed nephrostomy tubes are prepped and draped as well.  Initially a benson wire was advanced thru the LT Nephrostogram with contrast injection into the distal ureter shows complete obstruction of the distal ureter with mild hydroureter.  Multiple attempts at passing a wire into the urinary bladder were unsuccessful.  Then a Benson wire was advanced through the RT nephrostomy tube to the ureterovesical junction and contrast injection made.  This demonstrates a tight stenosis and a 5 french cathe was placed in the urinary bladder.  A 4 mm wide balloon was placed at the level of stenosis at the RT ureterovesical junction and balloon dilation performed.  Then a 8.5 french nephroureterostomy tube was passed into the urinary bladder and exited the right flank.  Pt. tolerated procedure well.  

I coded, LT 50393, 74425, 50398 & 75984   RT 50393, 74480.


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## dpeoples (Dec 12, 2008)

I looks like only one addtional ureteral nephrostomy was placed, on the rt. So:

50394LT
50394RT
74425 (LT & RT)
50393 RT
74480

I did not see an exchange documented, it seems they extented the nephrostomy on the right.

dp


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## pharmon (Dec 12, 2008)

THANK YOU a bunch!!! This helps.  I don't know why I let nepho's intemidate me LOL


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## krishna.k (Dec 24, 2008)

HI,

I agree with above coding in addition I would like to add few more codes 53889(to check fee value with provider)  we can bill for dilation stricture with ballon As  Per Clinical Examples in Radiology, Summer 2006, for balloon dilation of the ureter use 53889 and 74485.

Thanks.
Krishna.CPC


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