# Nephrostomy tube removal under fluoro



## suela923@aol.com (Jan 22, 2016)

I code for a hospital.  We have cases where the doctor removes a nephrostomy tube under fluoroscopic guidance.  Can we bill anything for this service?  I am being advised we can bill for the fluoro, 76000 or for a nephrostogram, 50431 or is there an e/m charge that as the hospital (not the doctor's office) I can use?  As always, thanks!,

History: Postpartum with nephrostomy tube in place. Evaluate for obstruction and for urolithiasis.

Technique: Written informed consent was obtained. Timeout was performed. Scout x-ray was performed. Antegrade right-sided nephrostogram was performed. PCN was cut and removed. Final x-ray of the abdomen and pelvis was performed. Patient tolerated the procedure well, no complications occurred.

Findings: Abdomen x-ray shows a right PCN in satisfactory position. No evidence of urolithiasis. Antegrade nephrostogram shows excellent position within the lower pole calyx. There is no hydroureteronephrosis. There is brisk flow of contrast into the collecting system down the ureter into the bladder. No evidence of obstruction or filling defect. PCN was removed and the final KUB confirms no obstruction with increasing contrast in the bladder.


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## Chlrtrep (Jan 25, 2016)

CPT: 50389  

Status Indicator
Q2 
Short Description
REMOVE RENAL TUBE W/FLUORO 

Long Description
Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent)


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## Jim Pawloski (Jan 27, 2016)

You can only use 50398 if a uretural stent is present. Otherwise, use the nephrostogram code.

Jim Pawloski, CIRCC


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## suela923@aol.com (Jan 28, 2016)

*50398?? Further question*



Jim Pawloski said:


> You can only use 50398 if a uretural stent is present. Otherwise, use the nephrostogram code.
> 
> Jim Pawloski, CIRCC



Jim,

The CPT book states Removal of nephrostomy tube, requiring flurorscopic guidance (eg, with concurrent indwelling ureteral stent)

I read that eg means "for example", thus this only being a description of one option

ie means " in other words" and is used for further clarification.  

Also, if as a biller for the hospital could I bill and e/m code if fluoro wasn't used or is that just for the physician's office?'

Thanks!
Sue


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## akila.p (Feb 1, 2016)

*50431*

Documentation doesn't states concurrent ureteral stent,so we have to code Antegrade right-sided nephrostogram(50431)

Akila.P.CPC


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## SENTHIL05 (Dec 27, 2016)

*50389*



akila.p said:


> Documentation doesn't states concurrent ureteral stent,so we have to code Antegrade right-sided nephrostogram(50431)
> 
> Akila.P.CPC



Procedure performed by using  Flurorscopic guidance and Technique&findings clearly saying PCN cut and removed so its should be cpt 50389.

(eg, with concurrent indwelling ureteral stent)

I read that eg means "for example", thus this only being a description of one option
ie means " in other words" and is used for further clarification.  like JIM mentioned above.

THANKS

SENTHIL V ,CPC


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