# Bilateral nephroureteral stent exchange



## Shirleybala (Dec 10, 2008)

Hi,

Help me to code this report can we code this as 50387-50

      The patient was placed on the angiography table in the prone
      position. Both flanks including the external portions of the
      nephroureteral stents were prepped and draped in the usual sterile
      fashion. 1% lidocaine was administered for local anesthesia of the
      skin and subcutaneous tissues. Preliminary scout film demonstrated
      bilateral nephroureteral stents with pigtails formed in the
      bilateral flanks and pelvis. Contrast was injected through the
      nephroureteral stents demonstrating proper positioning.

      Under fluoroscopic guidance an Amplatz wire was advanced through 
      the right stent and into the urinary bladder. The stent was
      removed.
      Over the Amplatz a new 8Fr 22cm long nephroureteral stent was
      placed on the right with the distal pigtail within the bladder and
      proximal pigtail within the renal pelvis. Proper position was
      confirmed with injection of contrast
      under fluoroscopic observation.

      Under fluoroscopic guidance an Amplatz wire was advanced through
      the left ureteral stent.  During advancement the right ureteral
      stent backout of the bladder.  The Amplatz wire could not be
      advanced further.  The Amplatz wire was then removed. A Glidewire
      was then advanced through the ureteral stent and advanced into the
      distal ureter.  The stent was removed.  Attempt at advancing a
      Berenstein catheter beyond the renal pelvis however were not
      initially possible.  The Glidewire was then retracted into the
      renal pelvis and redirected into the ureter.  This was then
      successfully advanced into the bladder.  The Berenstein catheter
      was advanced over the Glidewire into the bladder.  The Glidewire
      was exchanged for an Amplatz wire.  A new 8-French by 22-cm
      nephroureteral stent was advanced over the Amplatz wire and
      positioned with distal pigtail within the bladder and proximal
      pigtail within the renal pelvis.  The catheter was secured in
      position.  Position was confirmed with injection of dilute
      contrast material.  Once position of both catheters was confirmed
      a sterile dressing was applied to the exit sites.  The catheters
      were connected to gravity bag drainage.. The patient tolerated the
      procedure
      well, no immediate complications.

      Impression:  Exchange of bilateral
      nephroureteral stents with 8Fr 22cm stents placed bilaterally.


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## MLS2 (Dec 10, 2008)

I would do 50387-50 also.


50387:  The physician removes and replaces an externally accessible transnephric ureteral stent under fluoroscopic guidance. A transnephric ureteral stent is one that is placed through the wall of the flank into the renal pelvis and down into the ureter to keep the ureter open. Contrast may be injected at the entry site to assess anatomy and positioning. The suture holding the pigtail in place is cut and a guidewire is threaded through the stent lumen until it exits the distal end. The original stent is removed over the guidewire. Diameter and length are noted for a new stent, which is threaded over the guidewire until the distal end forms within the bladder. Fluoroscopy is used to assess the proximal position of formation within the renal pelvis. After position is verified, the guidewire is removed and the suture is put in position to hold the pigtail in place. Contrast may be injected to check position and function. Final adjustments are made for patient comfort, and the catheter may be sutured to the skin, capped, or a drainage bag may be attached.


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## ciphermed (Dec 10, 2008)

I agree as well...CPT Assistant, Sept. 2006 page 4 has a clinical example which supports the use of this code; also CPT indicates that mod -50 is appropriate when performed bilaterally.


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## Shirleybala (Dec 10, 2008)

Hi,

Thankyou for ur reply,


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