# Exchange Neph to Nephroureteral cath with ureteral dilatation



## Liza559 (May 23, 2012)

Coding help with this one.

Clinical Indication: GU tract malignancy. Obstruction. Pt. has nephrostomy catheters which have been very problematic, frequently becoming dislodged. Request is made to attempt internalization.Considering the situation and the future need for transurethral exchange and the uncertainty as to whether or not the patient can tolerate antegrade drainage, I elected to place bilateral nephroureteral stents rather than a seperate ureteral stent.

Procedure and Findings:
1. Bilateral antegrade nephrostogram
2. Bilateral ureteral angioplasty with nephroureteral stent placement

Patient placed prone. Left nephrostomy was addressed first. there is decompression although occlusion at the level of the sacral promontory. This was crossed without much difficulty using a 5 fr. catheter and glidewire. However, a 10 fr. nephroureteral catheter would not pass. Therefore, balloon dilatation was undertaken with a 6mm wide and 4cm long balloon at which point the catheteer was inserted over an amplatz guidewire and appropriately positioned with the securing loop in the bladder and the proximal loop in the renal pelvis.

Right side was then addressed. There was a high-grade stricture distally. Over a stiff shaft glidewire and a long 8 french arrow sheath, the occlusion was evetually traversed. The 6mm balloon catheter was used to dilate the stricture and second 10fr x 26cm long nephroureteral stent was placed.

At this point, contrast was injected showing rapid flow to the bladder. Catheters were capped and patient returned to floor. 

checking to see if appropriate to code 53899-50;74485-50;50387-50?


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## Jim Pawloski (May 24, 2012)

Liza559 said:


> Coding help with this one.
> 
> Clinical Indication: GU tract malignancy. Obstruction. Pt. has nephrostomy catheters which have been very problematic, frequently becoming dislodged. Request is made to attempt internalization.Considering the situation and the future need for transurethral exchange and the uncertainty as to whether or not the patient can tolerate antegrade drainage, I elected to place bilateral nephroureteral stents rather than a seperate ureteral stent.
> 
> ...



I would use 50393-50, 74425-50 for the nephrostograms, and 50394-50 and 74480-50 for the nephrouretural stent placements (these are considered uretural stent placements),and 53899-50 and 74485-50 for the uretural angioplasty.
HTH,
Jim Pawloski, CIRCC


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## donnajrichmond (May 24, 2012)

Jim Pawloski said:


> I would use 50393-50, 74425-50 for the nephrostograms, and 50394-50 and 74480-50 for the nephrouretural stent placements (these are considered uretural stent placements),and 53899-50 and 74485-50 for the uretural angioplasty.
> HTH,
> Jim Pawloski, CIRCC



Jim, do you have your codes backwards?  
50393 is ureteral stent placement and 50394 is nephrostogram. 

Donna


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## Jim Pawloski (May 24, 2012)

donnajrichmond said:


> Jim, do you have your codes backwards?
> 50393 is ureteral stent placement and 50394 is nephrostogram.
> 
> Donna



You're right!  I was answering this thread while working on a UFE.  Thanks for catching it.

Jim


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