# conversion to an open pyelolithotomy



## TAMMYS (May 10, 2010)

could use some help with this.  

Pt has cystoscope with retrograde pyelogram.  "an open ended catheter was passed up benealth the stone and using irrigation and movement of catheter, the stone was dislodged and seen to float back up into the renal pelvis.  The guidewire was then advanced and thought to be in the renal pelvis.......a stent was passed over the guidewire.  It appeared to be in postion, but futher observation showed it wasn't.  The stent removed, guidewire passed again.....multiple efforts were made but the guidewire could not be placed.  A rigid ureteroscope was then used under direct vision but could not be completed due to an apparent false passage.....

Decision to do an open pyelolithotomy....."using disection the proximal ureter was identified and was disected back up to the kidney.  I could palpate the stone in the renal pelvis.  Using a 12 blade knife, a pyelotomy was made and the stone was grasped and removed.  A stent was then place through a separate ureterotomy in the proximal ureter using a guidewire.....the pyelotomy and the ureterotomy for stent placement were closed under direct vision.

The codes I have would be:
50130
50605
74420

My question is can I code the 52332 with a modifier 53 or is it included due to the decision to convert to an open procedure.  

Any help would be appreciated.


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## Kelly_Mayumi (May 16, 2010)

If a endoscopic procedure is attempted, but not compleated, only the compleated service is billable.  I'd probably code 52351 since that was completed, and for the stent it sounds like it was put in through the open incision?  If so, what about 50605?


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