# Learning As I Go-no help



## kathy a (Feb 9, 2012)

Help! New to urology coding. Doctor states patient had a Nephrouteroscopy. Would this be # 52351, # 74485 and # 74420. Doctor mentions he did a retro-grade pyleogram in his notes. He doesnt talk of using any dyes but does use guidewires. Im confused?? 
Thanks...Kathy Albert,CPC


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## bill2doc (Feb 9, 2012)

Can you post the OP Report ?


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## kathy a (Feb 17, 2012)

With the patient under general anesthesia in the dorsal lithotomy position he was given 80mg of gentamycin IV prior to instrumentation. Then a 22- French rigid scope was passed via the urethra into the bladder.Left ureter was cannulated with a poly catheter that was advanced to the mid ureter and a retrograde pyleogram was performed-which revealed filling defect included the whole renal pelvis, suspicious for a tumor. Then a guidewire was advanced to the level of the left kidney. Then a 7- French rigid ureteroscope was advanced alongside the guidewire to the left ureteral orifice all the way to the mid ureter. During careful examination there was no evidence of stones in the distal ureter. Then a 7 -French flexible nephroureteroscope was advanced over a guidewire to the level of the renal pelvis, and the tumor present in the renal pelvis was identified. It was bleeding significantly after instrumentation. For that reasion the guidewire was removed. the patient will need to have a left nephroureterectomy. Hope you can help me with this. Is the Ingenix book on Urology a good book to get? Thanks alot.
Kathy Albert,CPC


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## ksw1972 (Feb 17, 2012)

Hi Kathy

A nephroureterectomy is either a 50234 (Nephrectomy with total ureterectomy and bladder cuff, through same incision) and the 50236 is through a separate incision. The retrograde pyelogram is a 52005. These two codes can be billed together

If you get the Ingenix 2012 Urology/Nephrology book, this is like a bible for you to code correctly. I use it daily to code.

Hope this helps

Kevin Sweeney, CPC


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## kathy a (Feb 20, 2012)

He only basically did a scope-no cutting-due to the bleeding. Would it still be this?Isnt
ectomy to cut? I'm still confused. Thanks Kathy


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## trinalankford (Mar 1, 2012)

ksw1972 said:


> Hi Kathy
> 
> A nephroureterectomy is either a 50234 (Nephrectomy with total ureterectomy and bladder cuff, through same incision) and the 50236 is through a separate incision. The retrograde pyelogram is a 52005. These two codes can be billed together
> 
> ...



Kathy actually said the patient had a nephroureterOSCOPY, not nephroureterECTOMY, and this seems to be corroborated by the op note.

The 50234 is nephroureterectomy (removal of), while 52351 is nephroureteroscopy (inspection by scope of).

From the report, she is actually looking for the scope and not removal of any organs.

I believe the 52351 is correct but am not currently at work so can't check CCI edits.

Hope this helps.


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## bprieto (Mar 5, 2012)

I would code it as 52351 and 74420 with modifier 26


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## kathy a (Mar 16, 2012)

Thanks everyone for your help. I did get the Ingenix Urology Coding book which also helps temendously with how the procedure was done, dx codes and CCI edits.  Thanks...Kathy


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