# Bilateral Nephrostomy,Bilateral Ureteral stent



## Shirleybala (Mar 18, 2009)

Hello All:
How to code this senario.
50390-5950
50392-5950
50393-5950
74425X2
74480X2
74475X2
is this correct. 
     1.  Bilateral Nephrostomy placement
      2.  Bilateral Ureteral stent placement.


      With the patient in prone position, both flanks were prepped and
      draped in the usual sterile manner and locally anesthetized with
      1% lidocaine.  Initially, under real time ultrasound imaging
      guidance a left lower pole posterior calix was accessed with a
      21-gauge needle.  An ultrasound imaged was recorded for the
      patient's record.  Contrast was injected and a nephrostogram was
      obtained, confirming the calyceal puncture.  The site was then
      dilated with a triaxial introducer set, and a been a 4-French
      Berenstein catheter was advanced into the distal ureter.  Contrast
      is injected and multiple images were obtained.  This demonstrates
      severe hydroureteronephrosis.  The ureter is occluded at the
      region of the pelvic inlet.

      Using a Berenstein catheter and an angled Glidewire, the occluded
      ureter was successfully traversed, into the bladder.  Over an
      Amplatz wire the tract was dilated and an 8-French double-J
      ureteral stent was deployed, positioned with the distal loop in
      the bladder and the proximal loop coiled within the renal pelvis.
      An 8-French nephrostomy catheter was left in place on the left as
      well.

      Using similar technique on the right side, a right-sided 8-French
      nephrostomy and 8-French 22 center long double-J ureteral stent
      were placed.  The only difference on the right is that two- stick
      technique was used, as the first ultrasound-guided access was into
      an infundibulum.  The second fluoroscopy guided access was
      directly into a posterior lower pole calix.  On the right there
      was only moderate hydronephrosis, and the right ureter occludes
      higher up, in the lower abdomen.

      At the end of the procedure both nephrostomy catheters were
      sutured in place and connected to an external drainage bag and
      sterile dressings were applied.  The patient tolerated the
      procedure well, left the department in stable condition.

      Impression:

      Bilateral 8-French 22 cm long ureteral stents placed, as well as
      bilateral 8-French nephrostomy catheters.


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## MLS2 (Mar 18, 2009)

50390-50-59-51
50392-50-59-51
50393-50
74425x2
74475-59x2
74480x2

that's what I would do...


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## Shirleybala (Mar 19, 2009)

Thankyou


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