# Cysto coding help



## lovetocode (Feb 27, 2010)

Please take a look at this op report, and let me know what codes you would use.

The patient is an 86-year-old white female, quite debilitated
with known significant peripheral vascular disease, who was seen
in the hospital in October 2009, with right hydronephrosis
secondary to large nonopaque stones.  A right double-J stent was
placed on an emergent basis at that time.  She has done well and
was scheduled for replacement of the stent presently.  Definitive
treatment of the stones radiolucent in the right kidney have been
deferred due to her medical status and the limited options for
treatment of the large radiolucent stones.  Plans at this time
were for her to have the double-J stent replaced.

The patient was taken to the operating suite.  She was placed in the
lithotomy position dorsally with some difficulty due to the fact
that she does have a left AK amputation.  Cystoscopy was
performed showing no intravesical lesions.  The right double-J
stent was identified.  The entire portion of the visible stent
was totally calcified.  Photos were obtained.  With some
difficulty the distal portion of the stent was grasped and pulled
to the urethral meatus.  The lumen and distal portion of the
stent could be seen due to the nature of the entire calcified
stent.  This was not appreciated on previous films because of the
radiolucent nature of the stone.
Fragmentation of the stone was carried out in the bladder
manually and the lumen was identified, however no wire, either
rigid or flexible, could be passed into the distal portion of the
stent suggesting total occlusion of the indwelling stent.  Thus,
an open-ended catheter was placed adjacent to the stent in place
and a retrograde pyelogram was then done, showing no evidence of
extravasation of the collecting system and no ureteral injury.
An 0.038 Glidewire was then placed into the right renal pelvis
and a second double-J stent, 26 cm 7-French, Optima stent, was
then placed into proper position radiographically and visually.
Upon completion of the procedure, the bladder was then drained.
A #18 Foley catheter was left in place.  The patient was taken
to the operative suite to the recovery room, having tolerated the
procedure well.

For ICD-9 codes, I am looking at 274.11, 591, and 996.64(?).
CPT codes: 52315 or 52318

Any help would be greatly appreciated.


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## Kelly_Mayumi (Mar 1, 2010)

How was the stone fragmented?  I'm thinking 52317 and 52332.


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## lovetocode (Mar 3, 2010)

Thank you for your help.  I agree with the 52332, however I was leaning towards the 52318 vs. 52317 because of patient's age and difficulty.  I do not have any additional information about the fragmentation of the stones.  Again, thanks for your input.


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