# Nephro tube change & nephrostogram



## suela923@aol.com (Jul 3, 2013)

We are having a discussion in our office on whether we can bill 50398,75984 for tube change and then also bill the 74425 for the nephrostogram, just not bill the 50394.  I don't think we can bill anything for the nephrostogram since it's routine.

This is the guideline being referenced:

“ CPT code 50398 describes change of a nephrostomy or pyelostomy tube. If the tube change occurs in a patient without new symptoms related to the tube, CPT code 50394 (injection procedure for pyelography through a nephrostomy or pyelostomy tube) should not be reported separately for the tube check. However, if the patient has new symptoms related to the tube, the provider may separately report CPT code 50394 with an NCCI-associated modifier for the tube check.” 

this is the dictation:

Right-sided antegrade nephrostogram with fluoroscopic guided right PCN exchange

History: Chronic indwelling right PCN. For routine exchange every 10 weeks.

Technique: Timeout was performed. Patient was placed prone on the fluoroscopy table and the right flank and existing PCN were prepped and draped sterilely. Antegrade nephrostogram was performed. Using fluoroscopic guidance, new 8-French PCN was placed over a wire. Completion antegrade nephrostogram was performed. Patient tolerated the procedure well with no complications.

Findings: Right-sided antegrade nephrostogram shows the PCN is in the renal pelvis in excellent position in the lower pole access. The collecting system is nondilated. No obvious obstructing stones.

New right-sided PCN was placed also into renal pelvis in excellent position on the completion nephrostogram. No evidence of a complication or structure.

Thank you.


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