# opinions



## MLS2 (Jun 30, 2010)

curious to see what everyone comes up with for this case...thanks!


PROCEDURE(S): 
Percutaneous Nephroureteral Stent Placement (Internal/External) 
Percutaneous Nephrostomy Tube Placement
Foreign Body Retrieval, Non Vascular

HISTORY: 
Nephrolithiasis 
INDICATION: 
Percutaneous Access for PCNL 


MEDICATIONS: 
Fentanyl 250mcg; Midazolam 5mg 
CONTRAST: 
Omnipaque 350, 15 ml 
COMPLICATIONS: 
None. 

TECHNIQUE: Following informed consent and verification of the correct patient identity and planned procedure, the patient was placed in the prone position and the left flank was prepped and draped in the usual sterile fashion. Puncture of the left renal pelvis was performed using Chiba 22-gauge needle. Contrast and air was injected and spot film imaging was performed as a percutaneous antegrade pyelogram. A posterior upper pole calyx was then punctured under fluoroscopic guidance using a 21-gauge needle. A Jeffrey sheath dilator set was placed. Catheter access to the bladder was achieved.  A second wire was placed.  

Over a wire an 8-French vascular sheath was placed.  Through this a 20-mm Amplatz gooseneck snare was advanced and was used to engage the existing internal double-J ureteral stent.  A ureteral stent was removed intact.

Over the original wire a 5-French Bernstein catheter, modified to serve as a percutaneous nephroureteral stent, was placed with the tip in the bladder.  Over the second Amplatz Extra Stiff wire a 10.2 French nephrostomy tube was placed. The side holes were positioned across the renal pelvis. The catheter was sutured to the skin and placed to external drainage.

FINDINGS:  The renal collecting system is decompressed.  There is a filling defect in renal pelvis, and several smaller defects in the lower pole calyces, consistent with nephrolithiasis.

INTERPRETATION:
1.  Percutaneous drainage of the left kidney with placement of a percutaneous nephroureteral stent and percutaneous nephrostomy tube as described above. 
2.  Successful percutaneous removal of the existing internal double-J ureteral stent as described.


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## Shirleybala (Jul 1, 2010)

Puncture of rt renal pelvis with pyelogram
50390-59
74425
Placement of nephroureteral stent
50393-59
74480
Placement of nephrostomy tube
50392-59
74475-59
Removal of ureteral stent using snare
50384
Posterior pole puncture
50390-59
77002-59 Fluoroscopic guidance for puncture

I had come up wit these codes, any changes are valuble.........


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## HNISHA (Aug 1, 2010)

MLS2 said:


> curious to see what everyone comes up with for this case...thanks!
> 
> 
> PROCEDURE(S):
> ...



I would prefer the following codes:

50390-59
74425
50382
50392-59
74475-59

Thanks,
Abdul Saleem CPC


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