# Case



## MLS2 (Jun 29, 2009)

I'm just curious to see how others would code this case...thanks!


COMPLICATIONS: 
None.

TECHNIQUE: Following informed consent and verification of the correct patient identity and planned procedure, the patient was placed in the prone position and the left flank was prepped and draped in the usual sterile fashion. Puncture of the left renal pelvis was performed using Chiba 22G needle. Contrast and air was injected and spot film imaging was performed as a percutaneous antegrade pyelogram. A posterior lower pole calyx was then punctured under fluoroscopic guidance using a 21G needle. A Jeffrey sheath dilator set was placed. Catheter access to the ureter was achieved using a five French Bernstein catheter and angled Terumo guide wire. An Amplatz Extra Stiff wire was placed. Through an 8Fr sheath, a 20mm snare was used to removal the inwelling JJ stent intact. Over the wire, an 8Fr sheath was reinserted. Through the sheath, the Terumo wire was reinserted into the ureter. Over the Terumo wire, a 5Fr bernstein catheter was advanced into the distal ureter. Over the Amplatz Extra Stiff wire, a 10.2Fr Multipurpose Drain was placed. The pigtail was formed and locked in the renal pelvis. The nephrostomy catheter was sutured to the skin and placed to external drainage. The 5Fr catheter was capped and sutured to the skin.

FINDINGS:
There is a bifurcated collecting system with stones in at least two different upper pole calyces. Therefore, a lower pole access was selected and performed as described. 

INTERPRETATION:
1.Successful percutaneous drainage of the left kidney with placement of a 10.2Fr Multipurpose Drain nephrostomy tube and a 5Fr nephroureteral stent as described above. 
2. Successfule snare removal of the left inwelling internal ureteral stent.


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## Jim Pawloski (Jun 29, 2009)

This is how I would code this:

Removal of internal stent via perc. approach - 50384

Nephrostomy - 50392 & 74475


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## drsnpatil (Jun 29, 2009)

*New*

CPT Codes:
74425
50384
50392-59
74475-59


Thanks for contributing such report with us, keep posting other facility interventional reports also.......

If anyone working with Cardiology  Intervention pls post sample reports for our practice...........THANKS IN ADVANCE


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## dhuston (Jun 30, 2009)

What about the nephroureteral stent part of the case?  How would you code that?

Diane Huston, CPC,RCC


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## dpeoples (Jul 1, 2009)

MLS2 said:


> I'm just curious to see how others would code this case...thanks!
> 
> 
> COMPLICATIONS:
> ...




The document needs clarification. Did he place a Nephroureteral stent or just a 5Fr catheter into the ureter? Based on just a catheter I would code as such:
50384 for the removal
50393/74480 for the catheter (nephroureterostomy) placed through the renal pelvis and into the ureter.

If there was a stent placed/replaced, then:
50382 .

I hope this helps,


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