# nephrostomy



## prabha (Aug 7, 2009)

Can we code the following procedure with 50688 & 75984? Do anyone have any other suggestions?

       History: Patient is an 80-year-old male with bladder cancer and
       urinary diversion through a ileal loop, left ureteral stricture
       status post placement of a reverse left nephrostomy tube through
       the stoma into the left renal collecting system referred for
       routine catheter exchange.

       Approach: Retrograde access through the stoma       

       Procedure: Continuous physiological monitoring was carried out
       throughout the procedure.  With the patient in the supine position
       the stoma was prepped and draped in the usual sterile fashion.
       The indwelling nephrostomy tube is noted to have retracted into
       the stoma.  It was retrieved under fluoroscopic guidance using a
       clamp.  A catheter nephrostogram was performed. Under fluoroscopic
       guidance the indwelling catheter was removed over a stiff
       guidewire and a new 10 French pigtail self retaining
       nephroureteral stent was placed with its distal tip in the renal
       pelvis and proximal loop formed within the ileal loop.  Aspirated
       urine was clear.  A completion nephrostogram was performed.  The
       catheter was  left to gravity drainage within the bag.  The
       patient tolerated the procedure without incident.

       Findings: The nephrostogram demonstrated minimal hydronephrosis
       with little visualization of the left ureter.  There is flow of
       contrast down the catheter into the ileal loop.

       Conclusion: Fluoroscopically guided replacement of a left 10
       French reverse nephrostomy catheter for a new 10-French by 24-cm
       left reverse nephroureteral stent with its distal tip within the
       renal pelvis and proximal loop within the ileal loop.  The stent
       exits the stoma to be placed to bag drainage within the ostomy
       drainage bag.


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## dpeoples (Aug 7, 2009)

prabha said:


> Can we code the following procedure with 50688 & 75984? Do anyone have any other suggestions?
> 
> History: Patient is an 80-year-old male with bladder cancer and
> urinary diversion through a ileal loop, left ureteral stricture
> ...




I agree with your code selection. 50688/75984

HTH


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## prabha (Aug 9, 2009)

*Nephrostomy*

Do we need to code catheter nephrostogram with this?


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