# Nephro tube Exchange...



## she803 (Apr 23, 2012)

Physician coded this report with cpt codes 50393-79; 50398-79; 50394-79; 99144; 74480-26; 74425-26; 75984-26. However, Medicaid denied this claim as cpt 50398-79 incidental cpt code 50393-79. Please assist. Thanks

History: This is 36-year-old male status post successful PCN now with reentry 
nephroureteral stent for down sizing to nephrostomy with internal double-J stent placement.

Procedure: The patient was brought to the indices in place on the NG tube prone position. Right flank in excluding 24 French reentry nephroureteral stent was prepped and draped in the usual sterile fashion. 1% lidocaine was used as local anesthetic. Percent and frontal were given for sedation. 

Under fluoroscopic guidance existing reentry catheter was exchanged for an Amplatz wire which was advanced into the ileal conduit. Over the Amplatz wire 8 French 26 cm long double-J stent was placed and formed in the renal pelves and ileal conduit. Covering 8F nephrostomy was placed over the wire. Satisfactory position of the double-J stent and nephrostomy was confirmed with contrast injection. Nephrostomy was secured to skin was a suture appears to dressing was applied. Nephrostomy was connected to the Beckford drainage to gravity. There were no complications. 

Impression: Uneventful down sizing of the right 24 French reentry nephroureteral stent two 8 French 26 cm long double-J stent with  8 French covering nephrostomy.


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## donnajrichmond (Apr 24, 2012)

she803 said:


> Physician coded this report with cpt codes 50393-79; 50398-79; 50394-79; 99144; 74480-26; 74425-26; 75984-26. However, Medicaid denied this claim as cpt 50398-79 incidental cpt code 50393-79. Please assist. Thanks
> 
> History: This is 36-year-old male status post successful PCN now with reentry
> nephroureteral stent for down sizing to nephrostomy with internal double-J stent placement.
> ...




Was the stent placed retrograde through the ileal conduit, or antegrade down to the ileal conduit


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## dpeoples (Apr 24, 2012)

she803 said:


> Physician coded this report with cpt codes 50393-79; 50398-79; 50394-79; 99144; 74480-26; 74425-26; 75984-26. However, Medicaid denied this claim as cpt 50398-79 incidental cpt code 50393-79. Please assist. Thanks
> 
> History: This is 36-year-old male status post successful PCN now with reentry
> nephroureteral stent for down sizing to nephrostomy with internal double-J stent placement.
> ...



my two cents worth. This is a case where the patients history must be factored. There is already a Nephroureteral stent and this looks like a simple exchange to me. The question (as Donna has asked) is:
(1)was this through the ileal conduit and retrograde up to the renal pelvis? or 
(2) from the renal pelvis down (antegrad) to the ileal conduit? That makes a huge difference?

If (1) all I see is 50688/75984 
If (2) all I see is 50398/75984

I have no opinion on the use of conscious sedation.

HTH


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