# bladder stone extraction w/urethrotomy cpt code help needed



## codegirl0422 (Dec 9, 2014)

PREOPERATIVE DIAGNOSES: 1. Bladder outlet obstruction.
2. Bladder stones.
3. Voiding dysfunction. Uroflow shows very poor flow.
POSTOPERATIVE DIAGNOSES: 1. Urethral stricture.
2. Bladder stone, see photographs.
PROCEDURE PERFORMED: 1. Cystoscopy. 
2. Urethrotomy.
3. Stone extraction from the bladder.	
INDICATIONS: The patient --- man with a history of significant voiding dysfunction with
frequency and urgency of urination, dribbling with incomplete emptying of bladder based on uroflow that
shows obstruction with retention. The patient has a history of bladder stone evident on ultrasound done in
my office. The patient now comes in for definitive management with endoscopy and removal of stones.
The possibility of: 1) bleeding; 2) infection; 3) scarring; 4) failure; 5) retention was discussed with
the patient.
PROCEDURE: The patient was taken to the operating room, placed under anesthesia, then in dorsal
lithotomy position the area was prepped and draped in the usual fashion.
Genitalia examination showed: 1) uncircumcised penis; 2) phimosis; 3) glans is healthy; 4) urethra is
normal; 5) both testes are normal; 6) prostate 40 grams, smooth, symmetric without nodules.
Endoscopy was done with 21 scope which showed: 1) distal urethra normal; 2) proximal urethra normal;
3) bulbar urethra normal, but showed a stricture in the mid bulbar urethra which was urethrotomized and
then dilated to 26 French, the scope was inserted; 4) membranous urethra is normal; 5) prostatic urethra
showed stones at the bladder neck which were photographed. The patient has had TURP in the past. The
stones appeared to be adherent to the bladder neck, which were dislodged and crushed with a crusher.
Then small particles were irrigated out. The bladder showed trabeculae with cellules and diverticula.
There are no tumors noticed, no carcinoma in situ. Efflux from each kidney is normal. After irrigation of
stones and extraction of stones with resolution the bladder was left partially full.
The patient was taken back to recovery. He will be discharged on antibiotics and pain medication, to
follow up in 2-3 weeks in my office or p.r.n.


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## Kavita Parab (Dec 9, 2014)

Hi,

As per my reserch the answer will be  CPT 52317 ( ie Litholapxy crushing or fragmentation of calculus by any means in bladder and removal of fragmanrs. simple or small ) because as per medical notes physician crushed stones with crusher and then small particles were irrigated out and then extracted.


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