# Nephrostomy-Pls clarify the codes



## elamathi (Jun 10, 2009)

Hi all,

Pls clarify the codes for the procedure performed.

INFORMATION:
Internal/externa nephroureteral stent in place, patient had urinoma and ureteral injury, nephroureteral i place approximately one week.
Consent  was obtained. 1% lidocaine utilized as local anesthesia. Divided doses of ed and fentanyl were utilized for conscious sedation. The patient’s cardiovascular ored. Procedure time was less than 30 minutes.
Utilizing an aseptic technique the existing catheter was injected with contrast and images obtained.  Over a wire the catheter was removed and an 8-French 22 cm internal only double pigtail ureteral stent was placed.  One pigtail portion was in the bladder.  Second portion was in the pelvis extending in to lower calyx.  External access was removed.  Patient tolerated the procedure well.
IMPRESSIO
1. Successful placement of an internal only ureteral stent, external access was removed.

2.Ureteral stnt could be left in place for 6-8 weeks and removed at that time.


----------



## dpeoples (Jun 10, 2009)

elamathi said:


> Hi all,
> 
> Pls clarify the codes for the procedure performed.
> 
> ...



"_Internal/externa nephroureteral stent in place, patient had urinoma and ureteral injury, nephroureteral i place approximately one week"_
If this procedure was coded 50392/74475 then the second procedure (based on the above note) would be 
50393/74480
50394/74425

If the first procedure was coded 50393/74480 then the above note would be 
50398/74480
50394/74425

I hope this helps.


----------



## elamathi (Jun 11, 2009)

Hi,

Do we need any interpretation to code 50394/74425.  Here the documentation states contrast was injected in the catheter and imaged.  Is this ok to code 50394/74425 or else we have to code 50393/74480 alone.  Right!


----------



## dhuston (Jun 11, 2009)

I was told at an RBMA coding seminar that a nephroureteral to ureteral stent exchange would be 50387.

In order to bill for 50394/74425 a true nephrostogram must have been done.  Often times contrast is injected just for roadmapping.  If you don't have an interp, a nephrostogram wasn't done.

Diane Huston, CPC,RCC


----------



## dpeoples (Jun 11, 2009)

*oops*



dhuston said:


> I was told at an RBMA coding seminar that a nephroureteral to ureteral stent exchange would be 50387.
> 
> In order to bill for 50394/74425 a true nephrostogram must have been done.  Often times contrast is injected just for roadmapping.  If you don't have an interp, a nephrostogram wasn't done.
> 
> Diane Huston, CPC,RCC



Diane is correct on both accounts. I made the error of assuming with the first injection, and I completely missed the _internal/external_ wording in the note.

In my defense, I do not code these often.


----------



## elamathi (Jun 18, 2009)

Hi,


How will you code when a nephrostomy catheter was removed using contrast injection(no interpretation) and the ureteral stent was placed through same access. Is this should be coded as 50398 or 50393. .  Clarify the codes..

Thanks
Elamathi


----------



## Shirleybala (Jun 18, 2009)

I will code it as 50393


----------

