# Nephrostomy-Can we code the



## prabha (May 15, 2009)

Can we code the following procedure with

50392
50394
50688
74475-26
74425-26
75984-26   

Kindly confirm.


       Left Percutaneous Nephrostomy Tube Internalization:

       Patient admitted for left sided hydronephrosis with an
       antegrade nephrostogram demonstrating a distal left ureteral
       stenosis now status post left-sided percutaneous nephrostomy tube
       placement.  Patient referred for left sided percutaneous
       nephrostomy tube internalization.

       Initial scout images demonstrates a left flank pigtail catheter in
       the expected location of the left renal pelvis.  
       The left flank, including the indwelling nephrostomy tube, was
       prepped and draped in the usual sterile fashion. The nephrostomy
       tube was then aspirated until clear.  A gentle injection of
       contrast through the nephrostomy tube was then performed to obtain
       an antegrade nephrostogram.  Multiple spot images were obtained.

       This demonstrated good positioning of the nephrostomy tube with
       its distal pigtail coiled within the left renal pelvis.  No
       hydroureteronephrosis is identified.  There is complete occlusion
       of the distal left ureter at the level of the ureteroenteric
       anastomosis.

       After the administration of local anesthesia, the catheter was
       then cut and removed over an Amplatz wire.  A 4-French glide
       Berenstein catheter was then advanced over the wire and positioned
       within the renal pelvis.  The Amplatz wire was then exchanged for
       a Glidewire and the catheter and Glidewire were used to select the
       left ureter.  The catheter was advanced over the Glidewire and
       positioned within the distal left ureter at the level of the
       obstruction.

       The Glidewire was exchanged for an Amplatz wire.  The catheter was
       then exchanged for a 7-French long sheath.  The 4-French glide
       Berenstein catheter was then readvanced over the wire and the
       catheter and Glidewire were used to attempt to cross the occluded
       distal left ureter.  The Glidewire was then advanced beyond the
       obstruction and the catheter was advanced over the wire.  A gentle
       injection of contrast was then performed which demonstrated a
       false passage with contrast flowing into the peritoneum
       surrounding loops of bowel.

       The catheter was then pulled back into the distal left ureter
       central to the occlusion.  An 018 gold tip Glidewire was then
       coaxially loaded through a 3-French catheter.  The catheter and
       Glidewire were then coaxially loaded through the glide Berenstein
       catheter.  The 018 gold tip Glidewire was then used to cross the
       occluded distal left ureter over which the 3-French microcatheter
       was advanced.  The 018 glide wire was then removed.

       A gentle injection of contrast was then performed through the
       microcatheter which demonstrated ileal folds confirming good
       positioning of the microcatheter within the ileal conduit.

       A V18 wire was then advanced through the microcatheter and into
       the ileal conduit.  The 4-French glide Berenstein catheter was
       then advanced over the wire and microcatheter and into the ileal
       conduit.  The V18 wire and microcatheter were removed.  A gentle
       injection of contrast confirmed good positioning of the catheter
       within the ileal conduit.

       The wire was then readvanced through the 4-French glide Berenstein
       catheter.  The catheter and Glidewire were then advanced through
       the ileal conduit and used to cannulate the ileal conduit stoma.
       The Glidewire was removed a gentle injection of contrast was
       performed.  This demonstrated free flow of contrast into the ileal
       conduit bag confirming good positioning of the glide Berenstein
       catheter outside the ileal conduit.

       An Amplatz wire was then advanced through the catheter and out the
       ileal conduit stoma to obtain through and through access.

       The catheter and sheath were then removed and the distal tip of
       the Amplatz wire were secured to the patient.  The patient was
       then repositioned into the supine position on the fluoroscopic
       table.

       The right lower quadrant, including the indwelling ileal conduit
       stoma and through and through Amplatz wire, was then prepped and
       draped in the usual sterile fashion.

       A 10-French by 45-cm multi-sidehole pigtail drainage catheter was
       then advanced over the wire and positioned with its distal pigtail
       coiled within the left renal pelvis.  The Amplatz wire was then
       removed and a gentle injection of contrast confirmed good
       positioning the retrograde nephroureteral stent with its distal
       pigtail coiled within the left renal pelvis.

       The catheter was then aspirated until clear and flushed with 10 cc
       normal saline.

       The ileal conduit ostomy bag was then repositioned over the stoma
       with the distal tip of the retrograde nephroureteral stent within
       the ostomy bag.       

       Impression:       
       Left-sided antegrade nephrostogram demonstrating occlusion of the
       distal left ureter at the level of the ureteroenteric anastomosis.

       Successful cannulation of the occluded left-sided ureteroenteric
       anastomosis and internalization with a 10 French x 45 cm
       multi-sidehole pigtail catheter retrograde nephroureteral stent as
       described above.


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## MLS2 (May 18, 2009)

I'm thinking an internalization of a neph. tube to a nephroureteral stent would be 74480/50393...


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