# Uretural Stent Exchange



## Jim Pawloski (Jan 19, 2012)

I have a patient who has a uretural stent with could not be removed from below.  So from a percutaneous approach, the kidney was accessed and through a sheath, the uretural stent was removed using an Amplatz snare.  A nephrouretural catheter was replaced through the kidney into the bladder.  Do I use just 50382 for the exchange alone, or do I add 50390/74425 to it foffr the access through the renal pelvis?

Thanks,
Jim Pawloski


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## K.hancin (Jan 20, 2012)

The more I read the more confused I'm becoming – good luck:

Quotes taken from 2011 Interventional Radiology Coding Reference by Zhealth

“Coding Instruction  7. Do use code 50382 when a ureteral stent is removed and replaced percutaneously. The removed stent must not be externally accessible.  This procedure requires a new percutaneous transnephric puncture. … includes all imaging, access and procedural work.”

Is is safe to assume that 50390 antegrade pyelogram is included?  


Two more quotes from Zhealth may help figure it out:

Example 1) Under sterile ultrasound guidance, access is gained with an Accustick set via the left posterior lateral flank into the dilated collecting system of the left kidney. Injection is performed, revealing a dilated collecting system (50390-59, 74425). A .018 safety wire is placed along side the .035 wire and the tract dilated. Utilizing an angled glide wire and Kumpe catheter, advancement into the bladder is achieved. Amplatz wire and coaxial placement of an 8 French ureteral stent (50393, 74480) is performed and the loop locked in the renal pelvis. Contrast injection is used to confirm position. A separate percutaneous nephrostomy is placed, as the urine is somewhat blood tinged (50392-59, 74475-59). Two days later the nephrostomy is removed under fluoroscopic guidance to avoid pulling out the ureteral stent (50389).

“Example 3) Thirty year old with fractured ureteral stent. This was not retrievable from a transurethral approach. Via a flank puncture, a dilated renal collecting system is imaged with a needle and contrast injection. Wire and sheath are placed. A snare is used to remove the stent. A new ureteral stent is placed. The sheath is removed (50382 – this code bundles percutaneous access, needle, wire, and sheath placement; old ureteral stent removal and new ureteral stent placement; contrast injections; guidance; and imaging).”

HTH


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## dpeoples (Jan 20, 2012)

Jim Pawloski said:


> I have a patient who has a uretural stent with could not be removed from below.  So from a percutaneous approach, the kidney was accessed and through a sheath, the uretural stent was removed using an Amplatz snare.  A nephrouretural catheter was replaced through the kidney into the bladder.  Do I use just 50382 for the exchange alone, or do I add 50390/74425 to it foffr the access through the renal pelvis?
> 
> Thanks,
> Jim Pawloski



Hi Jim,
I consider access inherent to the procedure and would not code separately. 
HTH


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## Jim Pawloski (Jan 20, 2012)

dpeoples said:


> Hi Jim,
> I consider access inherent to the procedure and would not code separately.
> HTH



Thanks for the replies. I thought is was part of the procedure, I just wanted to confirm my thoughts.

Happy Weekend,
Jim Pawloski,
CIRCC


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## donnajrichmond (Jan 20, 2012)

dpeoples said:


> Hi Jim,
> I consider access inherent to the procedure and would not code separately.
> HTH



I agree.  If you have CPT Changes 2006 they describe this


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