Urology Coding Alert

Question: One of my urologists did a cystoscopy and ureteroscopy with holmium laser lithotripsy of a renal stone. This is what the operative report states: “A retrograde pyelogram was performed and a cone tipped catheter was placed into the left ureteral orifice. Contrast was administered demonstrating a radiopaque calculus within the kidney pelvis and a narrow ureterovesical junction. A 0.235 super stiff guide wire and then a 0.2 sensor guide wire was advanced into the kidney. Over the super stiff guide wire a ureteral dilating sheath was attempted but met with resistance at the level of the mid ureter. A semi-rigid ureteroscope was then advanced under gravity irrigation to the ureteropelvic junction but was unable to navigate the ureteropelvic junction obstruction. The access sheaths were once again attempted but met with resistance in the mid ureter. Over the sensor guide wire a flexible ureteroscope was advanced to the level of the ureteropelvic junction. The ureteroscope was able to pass into the kidney. There was no evidence of any filling defects or tumors in this area. The stone was visualized within the renal pelvis and also seen under fluoroscopy. Using the holmium laser lithotripsy and the 200 micron fiber, the stone was fragmented until only a residual 4mm fragment was left. Smaller 2 mm fragments were too small to grasp with the basket. The 4 mm stone fragment which was left was retrieved for analysis with a Nitinol stone basket and passed off the table as an individual specimen. Over the existing guide wire a 6 French 24 cm stent was advanced into the ureteral pelvis, and the guide wire was then removed with satisfactory stent coiling both in the bladder and renal pelvis.” How should I code this procedure?

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