# Nephrostomy tube



## Shirleybala

Hi,
Can anybody suggest me how to coded this senario, i have coded only 50387 is some other code will come.    
      69 year old male with calculus in the right
      renal pelvis.  Patient status post right percutaneous nephrostomy
      placement.  Request made for ureteral stent placement.

      Procedure:  Initially the procedure was explained to the patient
      including risks, benefits and alternatives.  The risks discussed
      included but were not limited to bleeding, infection, renal or
      ureteral injury.  The patient understood, asked appropriate
      questions and signed informed consent. 15.0 minutes flouroscopy
      time.  20cc ultravist 300 used as contrast.  The patient received
      IV versed and fentanyl, administered and monitored by the
      interventional radiology nurse.

      The patient was placed prone on the angiography table.  The right
      flank and external portion of the nephrostomy tube was prepped and
      drapped in the usual sterile fashion.  Scout film demonstrates the
      catheter with pigtail formed in the right flank.  Contrast was
      injected confirming the catheter to be in proper position within
      the right renal pelvis.  The there is abrupt cutoff at the right
      ureteropelvic junction with little contrast flowing into the
      ureter. An Amplatz wire was advanced through the nephrostomy and
      exchange was made for a 7 French sheath.  Contrast injection
      demonstrates positioning of the sheath within the renal pelvis.
      Using a stiff glide wire a Berenstein catheter was advanced into
      the urinary bladder.  Contrast was an injected, confirming
      positioning within the urinary bladder. Exchange was then made for
      an Amplatz wire.  An 8 French by 26 cm long ureteral stent was
      then advanced over the Amplatz.  A loop was formed in the urinary
      bladder and renal pelvis.  An 8 French all purpose drainage
      catheter was then advanced into the renal pelvis.  The pigtail was
      formed and locked. Contrast was injected through nephrostomy
      demonstrating opacification of the renal pelvis and flow through
      the ureteral stent.  The nephrostomy was secured to the skin with
      3-0 prolene and a sterile dressing was applied.

      The nephrostomy was left to gravity bag drainage.  The patient was
      instructed to cap the nephrostomy when the urine became clear.  He
      was also instructed to the place the nephrostomy back to gravity
      bag drainage if he developed fever, pain or leakage around the
      nephrostomy.

      The patient tolerated the procedure well.  No immediate
      complications.

      Impression:  Successful placement of 8 French by 26 cm long right
      ureteral stent.  A covering 8 Fr nephrostomy was left in place.


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## MLS2

it sounds like this was a conversion of a perc. neph. to a nephroureteral stent...74425/50394, 74480/50393, and it sounds like the neph. tube was changed?? (75984/50398)
I'm looking at the Interventional Radiology Users' guide and this is how they're describing this procedure..."Conversion of a percutaneous nephrostomy to a nephroureteral stent"
It also mentions this:
"There is no operative code for a change of catheter since this is inherent in placing the nephroureteral stent.  However, if the procedure performed was instead placement of a double pigtail stent with the nephrostomy left in place, the code for a change of catheter 50398 would be added, as code 50393 only describes placement of the stent."


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## Shirleybala

I can get u, i think ur point of view is correct. How about code 50387 please explain me.
Thanks,
Shirley


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## MLS2

50387 is a nephroureteral stent change...meaning there was an NUS there, they removed it, and replaced it with another NUS.  This case there was a nephrostomy tube there that was converted into an NUS tube.


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## Hariharan

Hi,
We can code 50394,74425-26,50393,74480,50398-59,75984 since injection through nephrostomy was performed and stent was placed and nephrostomy catheter was placed for supportive purpose for the stent we considered this as exchange,coming to use of code 50387 it is only applicable when stent were replaced with stent.not for tube replacement with stent


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## MLS2

I agree


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