# balloon angioplasty  uretero-enteric anastomosis.



## Shirleybala (Jun 5, 2009)

Hello:
How to code  balloon angioplasty  uretero-enteric anastomosis.

       61-year-old female status post Indiana pouch creation status post
       left nephroureteral catheter referred for dilatation of the
       ureteral anastomotic stricture and exchange of the nephroureteral
       stent placement.

       Procedure:

       Following informed consent the patient was placed in the prone
       position and the right flank prepped and draped in a sterile
       fashion.  Intravenous versed and Fentanyl were administered for
       conscious sedation.  Physiologic monitoring was performed
       throughout the procedure.  Intravenous antibiotics were
       administered prior to the procedure.

       The previously placed catheter was prepped and draped in a sterile
       fashion.  Contrast was injected and digital images were obtained.
       The catheter was exchanged over a guidewire for a 7-French
       vascular sheath.  Contrast was injected and imaging of the distal
       left ureteral enteric anastomosis was performed.  These images
       demonstrate a moderate-grade narrowing of the ureteral enteric
       anastomosis.  This narrowing was dilated to 8 mm with a prolonged
       inflation.

       The tract was dilated to 10 F and an 10F, 24 cm long
       nephroureteral catheter placed with its distal loop forming in the
       bladder and its locking loop formed in the dilated right renalpelvis.

       The catheter was secured to the skin with adhesives and attached
       to gravity drainage.  The patient tolerated the procedure well and
       left the department in satisfactory condition.

       Findings:

       There is high grade narrowing of left uretero-enteric anastomosis.
       This was treated with balloon angioplasty a 8  mm and then stented
       with a 10-French nephroureteral catheter placed as described
       above.

       Impression:

       1.  Moderate grade distal left uretero-enteric stricture treated
       with balloon dilatation to 8mm .

       2. Exchange of previously placed 8-French nephroureteral catheter
       for a new 10-French, 24-cm long nephro ureteral catheter.


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## dhuston (Jun 5, 2009)

SIR states that ureteral balloon dilatation can be coded as 50553 or 53899 _based on your practice's understanding of the change in the CPT introductory language that took place in 2002_ and the CPT and CMS instruction to use the most closely descriptive endoscopic codes.

Diane Huston, CPC,RCC


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