# Bladder Neck Contracture Dilation / attempted contracture incision



## rgeib (Oct 26, 2018)

Looking for some advice on the following:

PREOPERATIVE DIAGNOSIS:  Bladder neck contracture.

POSTOPERATIVE DIAGNOSIS:  Bladder neck contracture.

OPERATION:  Cystoscopy, bladder neck dilation, Foley placement,
*attempted bladder neck incision.
*

INDICATIONS FOR SURGERY:
*The patient has a history of TURP in the past*    with bladder neck contracture and hematuria.  The patient    also has obstructive urinary symptoms, *comes in for bladder neck incision,
    ended up with dilation, *see below.

    DESCRIPTION OF OPERATION:
    The patient was identified in the waiting room and brought into the
    OR.  Preoperative antibiotics were provided.  Anesthesia was
    administered.  The patient was placed in lithotomy position, then
    prepped and draped in a standard sterile surgical fashion.  Time-out
    was performed.  Consent was verified.  Next, a 19-French cystoscope
    with a 30-degree lens was inserted into the urethra.  No strictures
    in the anterior urethra.  Prostatic fossa appeared open.  The
    bladder neck was very tight and contracted.  I could not easily pass
    the scope.  Next, a Sensor wire was passed through the scope into
    the bladder.  The scope was removed.  Next, I decided to dilate the
    bladder neck a little bit so I can pass the urethra tome with the
    Collins knife using blue plastic dilators.  I slowly dilated the
    bladder neck from size 18 to size 24, which was the biggest dilator
    I had.  *The Collins knife was only available to use with the
    26-French sheath and obturator.  I removed the wire and slowly tried
    to pass the 26 sheath with an internal obturator.  I did meet some
    resistance at the bladder neck.  I then stopped.  Inserted a camera.
    I could see the bladder neck opening, but also the patient appeared
    to have a false passage to the right side at the level of the
    prostate.  I then decided to just leave a Foley catheter.*  Again, I
    placed a 19-French scope, passed a wire into the bladder.  I again
    passed a dilator.  The 24-French dilator passed easily into the
    bladder without resistance.  A 22-French Council tip Foley catheter
    was then passed over the wire into the bladder.  Balloon inflated
    with 15 mL of sterile water.  Urine output was clear.  No hematuria
    was noted.  The patient tolerated the procedure well, was sent to
    recovery room in stable condition.

At first, I was planning to just bill 52281 for the contracture dilation, but since the intent was to initially do the incision, would it be more appropriate to bill as 52276-52? I have read articles from the AUA's Michael Ferragamo stating 52276 is appropriate for contracture incisions secondary to prostatectomies.  Any help would be appreciated. Thanks in advance.


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