# Need help!!! nephrostogram with exchange of right nephroureteral stent



## sheilacpc (Sep 14, 2012)

This is a 65-year-old female with right nephroureteral stent catheter in place. Patient presents with acute onset of significant decreased amount of output draining from the right nephroureteral catheter. 
Procedure:
The patient presents for a nephrostogram with exchange of right nephroureteral stent. After being placed in the prone position, the right nephroureteral stent catheter was prepped and draped in normal sterile fashion. Injection of the catheter was performed under fluoroscopic imaging, which confirmed good positioning of the existing nephroureteral stent. The right nephroureteral catheter was then removed over a guidewire and a new 8 French nephroureteral catheter was positioned and locked in place. Confirmation of position was made with injection of radiopaque contrast and then the catheter was sutured in place. Sterile dry dressings were applied to the flank region. 

Which is the correct answer?:

50387-RT

50387 (no RT or LT modifiers are allowed on CPT codes for surgical intervention)

OR

50394 74425-RT  50398 75984-RT

Thanks,

Sheila


----------



## Jim Pawloski (Sep 14, 2012)

sheilacpc said:


> This is a 65-year-old female with right nephroureteral stent catheter in place. Patient presents with acute onset of significant decreased amount of output draining from the right nephroureteral catheter.
> Procedure:
> The patient presents for a nephrostogram with exchange of right nephroureteral stent. After being placed in the prone position, the right nephroureteral stent catheter was prepped and draped in normal sterile fashion. Injection of the catheter was performed under fluoroscopic imaging, which confirmed good positioning of the existing nephroureteral stent. The right nephroureteral catheter was then removed over a guidewire and a new 8 French nephroureteral catheter was positioned and locked in place. Confirmation of position was made with injection of radiopaque contrast and then the catheter was sutured in place. Sterile dry dressings were applied to the flank region.
> 
> ...



I would bill 50394/74425-59 and 50387, assuming the nephrostogram was diagnostic leading to the exchange.
HTH,
Jim Pawloski, CIRCC


----------

