# POUCHOGRAM/rETROGRADE INTO COLONIC POUCH



## margaret fahy (Oct 28, 2013)

Guys,
Not really an IR, but do you code these, or if you did, which procedure code would you use?
Thanks.
Margie

Indications:    

Reason:21 year old girl with history of small neurogenic bladder s/p creation of transverse colon conduit with stomal pain, please evaluate conduit    



Interpretation:  Pouchogram 
History.21-year-old with history of small neurogenic bladder,
post transverse colon conduit, stones  seen in the right ureter
is CT scan October 09, 2013
Technique retrograde contrast water-soluble contrast  into the
colonic pouch following placement of the Foley catheter placement
of 5 cc air in ballon in   the opening, of conduit

Finding plain radiograph of the abdomen prior to the study shows
absence of sacrum and coccyx. Surgical clips is seen in the right
side of the pelvis, ostomy seen on the left side overlying the
left iliac bone.  
No filling defect is seen within  conduit pouch, no extravasation
of the contrast seen through the conduit. Initially reflux
occurred to the left mildly dilated and tortuous ureter up to the
collecting system which is moderately dilated, later reflux
occurred into right ureter reaching  the  right collecting system
without obstruction collecting system of the right kidney is
mildly dilated following removal of the Foley catheter the pouch
is completely drained, residual contrast is seen within the
tortuous left ureter and dilated . left collecting system, and
collecting system of the right kidney.

IMPRESSION
 Colonic conduit demonstrate  with  no evidence of
extravasation or obstruction, reflux of contrast seen first  to
the left ureter and collecting system followed to the right
ureter and collecting system without obstruction.


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## margaret fahy (Oct 31, 2013)

*Retrograde into Colonic Pouch*

Hey Guys,
Can someone give me an opinion on this?


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## dpeoples (Oct 31, 2013)

margaret fahy said:


> Guys,
> Not really an IR, but do you code these, or if you did, which procedure code would you use?
> Thanks.
> Margie
> ...



This is kinda tricky, it is not a colon pouchogram, it is an injection of an ileal conduit made for urinary diversion. I would code this 50690/74425.

HTH


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## margaret fahy (Oct 31, 2013)

*Pouchogram/ileal conduit*

Dear True...
I see...you are absolutely right.  we get a code that comes thru.  this one came thru with 49465, so i wasn't going to bill that, and it wasn't a fistulogram...was not sure...going to make a notation in my book...cool.
Thanks so much, and have a peaceful weekend.
Margie


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