# need help/ nephrostogram



## chembree (Sep 18, 2009)

Can someone help me code this? For some reason this report is confusing me. I have xxxx out the Dr's name but two Doctors were involved. 



INDICATION: Left kidney stone, abdominal pain.

PROCEDURE: Under fluoroscopic guidance, percutaneous access along the left posterior abdominal wall and into the left kidney in the region of the left large kidney stone was performed. There was direct visualization of the needle tip adjacent to the left kidney stone. However, contrast injection through the access needle around the kidney stone did not demonstrate a calyx or infundibulum. A guidewire could not be advanced around this kidney stone. The stone most likely represents a parenchymal stone and not a stone within a collecting system.

A retrograde pyelogram was performed through an existing left ureteral catheter which demonstrates a left mid to upper renal pole calyx which is dilated and does not drain easily. Therefore, a second percutaneous access was achieved along the left posterior abdominal wall between the eleventh and twelfth intercostal space under fluoroscopic guidance and utilizing a 22-gauge access needle into this dilated calyx. This was followed by placement of a guidewire through the access needle into the dilated calyx and through a stenotic infundibulum under fluoroscopic guidance. The guidewire was advanced into the left renal pelvis and into the distal left ureter. This guidewire was secured. Dr. xxxxx utilized this percutaneous access for balloon dilatation of the stenotic infundibulum. Please refer to Dr. xxxxx's surgical report. This procedure was performed in the operating room.

IMPRESSION:
1. Left lower renal pole parenchymal calcification/stone.
2. Status post fluoroscopic guided placement of percutaneous axis guidewire into left mid to upper renal pole dilated calyx due to stenotic infundibulum. This procedure was performed under fluoroscopic guidance and in the operating room under complete sterile technique. Please refer to Dr. xxxxx's surgical report.


----------



## dpeoples (Sep 23, 2009)

c422rad said:


> Can someone help me code this? For some reason this report is confusing me. I have xxxx out the Dr's name but two Doctors were involved.
> 
> 
> 
> ...



ok, here goes:
50394/74425 for pyelogram through the existing catheter.

for the second procedure you should charge the same the other doc is charging and apply a modifier 62 IMO since this doc established the access being used.

HTH


----------

