# dilation of strictured ureter



## Lisa Heikes (Nov 11, 2009)

I'm not sure if the dilation can be coded or how to code it?

A #21 French cystoscope was inserted transurethrally under direct vision.  The right ureteral orifice was visualized and cannulated with a 7-French vonandel catheter.  Isovue contrast was injected as the distal ureter was imaged fluoroscopically.  The stone was identified about 4 cm proximal to the ureteral orifice.  There was also a strictured area of the ureter distal to the stone.  
A 0.038 glidewire was then inerted and advanced through the ureter to the renal collecting system.  A 4cmX5cm ureteral dilating balloon was advanced over the glidewire.  This was gradually inflated with contrast.  20 atmospheres of pressure were required to finally dilate the strictured area of the distal ureter.
The cystoscope and dilating balloon were removed. A rigid ureteroscope was inserted alongside the glidewire.  The stone was visualized.  The holmium YAG laser and 365 laser fiber were used to fragment the stone into several pieces of 1-2mm dimensions.  A helical stone basket was then used to sweep the fragments from the ureter into the bladder.  One of the fragments was retrieved and submitted for analysis.  
In order to minimize postoperative pain from obstruction a ureteral stent was inserted.  This was accomplished by reinserting the cystoscope over the glidewire and then advancing a 24cm X7 French percuflex stent over the glidewire. The proximal end was positioned in the renal pelvis and the distal end was left cureled in the bladder.

The codes I have are 52353, 52332, 76000.

Thanks for any help.


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## Kelly_Mayumi (Nov 11, 2009)

Check you bundling because I believe 76000 is bundled to those procedures, otherwise, I think it looks okay.


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