# ASC Uro procedure help needed!



## Ksumansky (Jun 3, 2009)

Hello,  I am having a hard time coding this case.  Any suggestions would be a big help.  I kinda need it asap due to the month end.  Thank you in advance.

Post op dx: Pneumaturia, recurrent UTI, confirmed rectovesicofistula and rectovaginal fistula.  A direct rectovesciovaginal fistula could not be demonstrated.

Operation performed:  Cystoscopy, bilateral retrograde pyelograms with fluoroscopic interpretation, fulguration of bladder base and fistulograms, vaginoscopy with fistulogram.

Procedure:  .......A 23 french cystoscope was advanced into the bladder and inspection showed normal ureteral orifices with a mild amount of edema and erythema of the trigone just behind the interureteric ridge with an apparent midline fistula.  There was no foreign material in the bladder.  The rest of the bladder mucosa was carefully inspected showing no other areas of suspicion.  A 4 french open-edned pollack catheter was advanced into the right orifice and contrast was injected and under fluoroscopic observation, the right kidney collecting system and ureter were completely normal.  The Pollack was then advanced into the left orifice and again fluoroscopy confirmed a normal left intrarenal collecting system and ureter without obstruction and the drainage was complete on follow up studies.  The tip of the pollack catheter could not advance into the fistula on the floor of the trigone, but did stir up bleeding.  The roller electrode was then used to obtain complete hemostasis of the tissue and in doing so identified a central pit consistent with a fistula.  The pollack catheter was then readvanced into this and contrast injected showing free flow of contrast into the rectum.  The cystoscope was then placed into the vagina and at the end of the vault there was mucoid tissue.  The pollack catheter was then advanced into this and easily advanced and contrast was injected showing it to be the sigmoid colon.  With manipulation of the catheters from both the vagina and the bladder a direct communicatin between the vagina and the bladder could not be demonstrated, but appeared that both were in communication with the rectosigmoid junction area.......

I came up with 52005-50, 57420, 53899 (for the hemostasis), 20501, 74420, & 76080.

Or   52214, 57420, 20501, 74420, &76080.  

I think I have way to many codes....Please help.....


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