# Nephrostomy removal without a stent



## jtuominen (May 28, 2009)

Wondering how others code a nephrostomy tube removal when there is no indwelling stent.

Do you use:
50394
74425
To bill just for the injection before removal

Or 
50389
Even though there is no indwelling stent?


Thanks!


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## dhuston (May 28, 2009)

I don't believe that 50389 requires that there be a stent present.  But it does require that the nephrostomy be removed under fluoro guidance.  And since I don't know the reason for the removal, I should probably also say that I wouldn't code the removal if it was for the purpose of placing a nephrostomy or stent.  The injection to check the tube before removal is bundled into 50389 but a true nephrostogram would be 50394/74425, again depending upon on the circumstances and what the report actually documented.  

Diane Huston, CPC,RCC


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## jtuominen (May 29, 2009)

Here is the dictation:


NEPHROSTOMY TUBE CHECK LEFT  May 26, 2009 12:38 PM 

HISTORY: Nephrostomy tube check. History of stones. 

COMPARISON: 5/20/2009.

FINDINGS: Existing nephrostomy tube was injected with contrast. There
is good drainage from the intrarenal collecting system into the
bladder. Therefore, the nephrostomy tube was removed.

The patient tolerated the procedure well. There were no immediate
postprocedure complications. The patient's vital signs were monitored
by radiology nursing staff under my supervision and remained stable
throughout the study.

Medications: None.

Fluoroscopy time: 0.7 minutes.

IMPRESSION: Good drainage from kidney to bladder on the left.
Nephrostomy tube removed.


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## luz.buenaventura (May 29, 2009)

50389 -Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent) 
This code requires only fluoroscopic guidance but not the stent. The indwelling ureteral stent is only an example of when this procedure is done.


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## dhuston (May 29, 2009)

Personally and without any additional knowledge of your doctors, I would code this based on this documentation as an E&M code.  I say this because:

1)  I don't know that the fluoro was used for the purpose of removing the nephrostomy.  My docs use also use fluoro to inject the tube and I tell my docs that they MUST specifically document that the nephrostomy was removed under fluro guidance.

2)  The injection was not a true nephrostogram.  It just looks at the tube.  A nephrostogram evaluates the urinary system.

My opinion is based on RBMA and SIR coding guidelines.

Diane Huston, CPC,RCC


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## jtuominen (May 29, 2009)

Thanks very much. I have always felt that the nephrostogram code was perhaps not the best capture, but since they don't usually specify if the fluoro was for the removal I just get stumped between the nephrostogram and the removal codes. Perhaps a documentation beef-up is in order


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