# Duble J stent



## MMillercpc (Sep 16, 2009)

Provider is doing a cystourethroscopy with insertion of an indwelling ureteral stent. The patient already has an existing ureteral double J in. They remove it perform lithotripsy on stones ...

She did have a positive urine culture prior to operation
and had been treated with Cipro several days prior to the operation. Of note, her
bacteria in her urine culture was sensitive to gentamicin. To begin, a 22-French
cystoscope was navigated through the patient's urethra into her bladder. Her
bladder was drained. We then performed a full cystoscopy. NO lesions were seen. The left right double J stent was seen on the right side. Teh left ureteral orifice was observed. It was noted to be wide open and feely excreting urine. We then turned our attention
back to the double-J stent. This was grasped with an alligator forceps and pulled
out of the meatus. Using a wire, we went through the cannula of the double-J
stent and the wire was then seen to curl in the patient's upper tract. The double-
J stent was removed. A 8-10 coaxial dilator was then used up over this wire in
order to place an accordion device proximal to the two stones which could be
seen on fluoroscopic images. The accordion was deployed. We then took a
semirigid ureteroscope and navigated our way up the patient's right ureteral
orifice. The first stone was visualized in the distal right ureter. Using a 365-
micron laser fiber, we proceeded to dust this stone into extremely small
fragments. We then moved past this and found a more proximal stone, which
was again distal to our accordion device. Again, this stone was ablated with 365-
micron laser fiber into multiple small fragments. The accordion device was then
used to sweep the ureter free of fragments. Following its removal, the ureteroscope was redeployed and no large fragments were seen in the patient's
ureter. The scope was removed. Under fluoroscopic guidance, a 6 X 24 double-
J stent with strings intact was placed. Good curl was seen in the kidney, as well
as the bladder at the end of this. Scope was then replaced for drainage of the
patient's bladder. She was aroused from anesthesia and taken to the recovery
room in good condition.

I am thinking that I need to code for the removal of the current stent??Would I as well code for the fluro?

I coded 52332rt,52353rt,52310-59-rt    

The patient is a 24-year-old female who
several months ago presented to Valley Medical Center with signs and
symptoms of obstructive pyelonephrosis on the right side. She also had a distal
left ureteral stone greater than 1 cm in size at the distal left UVJ. She was taken
to the OR, given the fact that she had obstructions bilaterally, as well as an
obstructive pyelonephrosis on the right side
As far as Diagnosis I have 592.1, 590.80


----------



## Kelly_Mayumi (Oct 26, 2009)

52310 will bundle to 52332.  You have to take the stent out in order to put a new one in, right?


----------

