# ureterosopcy with extraction of clot?



## daniel (May 15, 2012)

A 20-French cystoscope was inserted into the bladder. The left ureteral orifice was identified and large dense fibrin clot could be seen emanating from the ureteral orifice with ecchymosis around the ureteral orifice. We subsequently grasped the clots and pulled it out. We then placed a glidewire which seem to go easily up to the kidney. We placed an end hole catheter up the shot dye, which opacifies the collecting system showing that we were in the collecting system. We then inserted a dual lumen catheter and placed two standard guidewires, one of the wires placed the MR6 ureteroscope through the orifice and up distance of 1cm. We grasped some clots and pulled it out and up 2cm. There was a very narrow ureter and we could not get above this area without balloon dilatation as there was no stone on CT and there was some small filling defects, which was looked like clots, who has had to go ahead and place a stent subsequently. 


Need some input on this one, CPT 52001 seems close but not quite the fit.

Thanks
Daniel,CPC


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## mkpeters (May 16, 2012)

I have billed 52005 & 52001 w/mod 51 for this procedure. Also whenever we bill 52005 we add 74420 w/mod 26


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## Kelly_Mayumi (May 26, 2012)

If you placed a stent due to the narrow ureter and are going to try again later, I'd 52332 and 74420, 26.  52001 will likely bundle to 52332 but modifier -59 is allowed.  I usually only use 52001 when clots are obstructing the view for the doctor and an extended amount of time is used to irrigate them out.


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