# Nephroureterostomy procedures



## iamlou (Nov 5, 2014)

Any input on this? I'm not sure if this should be made 2 new procedures, or replacement procedures. 
 I got codes 50384, 50392/74475, 50393/74480. Or....50398/75984, and 50393/74480. Thanks for any help!! 

HISTORY:
Patient presents with urinary tract obstruction and had a combination
nephrostomy tube double-J stent catheter placed at an outside institution.
That catheter has been inadvertently partially withdrawn. The situation was
discussed with the patient's family and with Dr. xxxx.  It was elected to
exchange this catheter for a separate double-J stent and a separate
nephrostomy tube system in hopes that the nephrostomy tube can eventually
be withdrawn.
PRE-PROCEDURE DIAGNOSIS:
Urinary tract obstruction, borderline renal failure
POST-PROCEDURE DIAGNOSIS:
Same
PROCEDURES PERFORMED:
Removal of the indwelling nephroureterostomy catheter and placement of a
separate 8 French 20 cm double J stent and a separate 8.5 French
nephrostomy tube
ACCESS SITE:
Existing nephrostomy tube tract
CATHETER POSITION:
Not applicable

TECHNIQUE:
Sterile technique and local anesthesia was utilized.  The indwelling
nephroureterostomy catheter was removed over a hydrophilic  guidewire. This
was accomplished without incident.  A 6 French sheath was advanced into the ureter. A second wire was placed in the ureter to maintain access.
Utilizing standard technique an 8 French 20 cm double-J stent was then
positioned.  One end was coiled in the urinary bladder,  the other in the
renal pelvis. An 8.5 French nephrostomy tube was then placed over the
second wire to provide drainage and access to assure the double J stent is
functioning. This also was accomplished without incident
Completion study show excellent nephrostomy tube and double-J stent
position with good flow into the bladder
COMPLICATIONS:
None.
IMPRESSION:
SUCCESSFUL EXCHANGE OF THE PARTIALLY WITHDRAWN NEPHROURETEROSTOMY CATHETER
FOR A SEPARATE DOUBLE-J STENT AND SEPARATE NEPHROSTOMY TUBE
THE URINE IS CLEAR AT THIS POINT
CATHETER SHOULD BE LEFT TO EXTERNAL DRAINAGE UNTIL THE PATIENT'S LABS
STABILIZE AND THE URINE IS CLEAR. ONCE THE LABS ARE STABILIZED AND THE
PATIENT'S URINE IS CLEAR THE NEPHROSTOMY TUBE CAN BE CHECKED TO ASSURE
PATENCY OF THE DUCT.  THE NEPHROSTOMY TUBE SHOULD BE LEFT TO EXTERNAL
DRAINAGE UNTIL THE URINE IS CLEAR AND UNTIL THE PATIENT'S  LABORATORY
VALUES ARE STABILIZED.
ONCE THIS OCCURS PATENCY OF THE DOUBLE-J STENT SHOULD BE DOCUMENTED
UTILIZING A CONTRAST INJECTION, AT THAT POINT THE NEPHROSTOMY TUBE LIKELY
CAN BE WITHDRAWN


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## mceisele (Nov 7, 2014)

I vote for 50398/75984, and 50393/74480.  This sounds similar to the question in the March 2012 _CPT Assistant _FAQ. 

Celeste


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## iamlou (Nov 10, 2014)

That sounds perfect! Thanks, Celeste!


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