# Bilateral nephrostogram-enough findings



## suela923@aol.com (Apr 17, 2013)

Are there enough findings on this dictation to bill for a bilateral nephrostogram?

Bilateral nephrostogram and replacement of left percutaneous nephrostomy tube with insertion of internal/external nephroureteral catheter on the left.

History: This is a 24-year-old female with a large pelvic mass due to ovarian carcinoma. She has bilateral ureteral obstruction. She had a previous placement of bilateral nephrostomy tubes. The right nephrostomy catheter has been functioning well and the left has had its output diminished to 0. Physical examination shows the left nephrostomy catheter to be pulled back.

Bilateral nephrostograms were performed. The right nephrostomy catheter was injected with contrast. It is well-positioned. There is narrowing of the distal ureter, but there is flow into the bladder. There is mild dilatation of the right intrarenal collecting system.

Injection of the left nephrostomy catheter shows the catheter to be dislodged. Contrast did not flow into the renal collecting system. I attempted to traverse this tract using a catheter guidewire combination, but was not successful. A new nephrostomy had to be inserted. This was done using fluoroscopic guidance. A lower pole calyx was entered using a 22-gauge needle. Contrast was injected, the tract dilated and an internal/external nephroureteral catheter was inserted. Distal tip of this catheter is coiled in the patient's bladder and the proximal portion of the catheter could not be coiled in the renal pelvis as is the usual custom. Patient's renal pelvis is very small.

A perirenal urinoma was encountered during the study. This likely resulted from dislodgment of the previous catheter and leakage of urine into the perirenal apace.

IMPRESSION:


Left nephrostomy catheter had become dislodged and needed to be replaced. A new nephrostomy catheter was inserted and a nephroureteral tube inserted on the left side. The distal tip of this catheter is in the bladder.

The right percutaneous nephrostomy catheter remains in position.

Thanks for any input!  
Sue


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## dpeoples (Apr 17, 2013)

suela923@aol.com said:


> Are there enough findings on this dictation to bill for a bilateral nephrostogram?
> 
> Bilateral nephrostogram and replacement of left percutaneous nephrostomy tube with insertion of internal/external nephroureteral catheter on the left.
> 
> ...



I think so. Since this was not a routine exchange (there were indications of a problem), I would code:
50393/74480 for the new nephroureteral stent/cath placement
50394-59/74425 for the left tube injection
50394-59/74425 for the right tube injection

other modifiers may be required depending on payor preference.

HTH


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## suela923@aol.com (Apr 18, 2013)

*Additional question on bilateral nephrostogram*

Thanks!  I have one more question....my trainer had me bill this as 50393,74480 Ureteral Stent instead of 50398, 75984...would you agree?

I am really struggling with the terminology used for tubes, cathethers and stents.  Sometimes it seems that the doctor will use all 3 terms when referencing the same procedure.  How can I tell the difference?

Thanks again for your help!!!
Sue


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## dpeoples (Apr 18, 2013)

suela923@aol.com said:


> Thanks!  I have one more question....my trainer had me bill this as 50393,74480 Ureteral Stent instead of 50398, 75984...would you agree?
> 
> I am really struggling with the terminology used for tubes, cathethers and stents.  Sometimes it seems that the doctor will use all 3 terms when referencing the same procedure.  How can I tell the difference?
> 
> ...



Yes! sorry I missed that. I will edit.


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