Do i code the injection and the tube placement?
50390 74425 & 50392 74475
or just...50392 74475
Reason for Study: HYDRONEPHROSIS
Reason For Visit: ACUTE RENAL FAILURE HYPERKALEMIA
Procedures: 1. Nonvascular ultrasound, limited.
2. Ultrasound guided aspiration.
3. Fluoroscopically guided drain placement.
4. Antegrade nephrostogram.
Complications: None.
Medications: 1 mg Versed and 50 mcg fentanyl IV.
Technique: After the risks, benefits and alternatives were explained to the patient and written, informed consent was obtained, the patient was placed prone on the fluoroscopic table. The left back and flank were prepped and draped in sterile fashion and 1% lidocaine was used for local anesthesia. With ultrasonographic control the posterior calyx of the left kidney was accessed with an 21-gauge needle and then an 018 inch wire was placed. The needle was exchanged for the Accustick system and contrast was instilled to
Findings: 1. Minimal-moderate hydronephrosis left kidney. A permanent image was obtained and stored.
2. Ultrasound guided percutaneous access to left renal collecting system via a midpole calyx.
3. Fluoroscopically guided 8 French percutaneous nephrostomy tube placement with pigtail in the renal pelvis. Permanent image stored in the digital picture archive.
4. Antegrade nephrostogram demonstrates moderate hydronephrosis and proximal hydroureter left kidney.
Impression: Successful left percutaneous nephrostomy tube placement with ultrasound and fluoroscopic guidance.
50390 74425 & 50392 74475
or just...50392 74475
Reason for Study: HYDRONEPHROSIS
Reason For Visit: ACUTE RENAL FAILURE HYPERKALEMIA
Procedures: 1. Nonvascular ultrasound, limited.
2. Ultrasound guided aspiration.
3. Fluoroscopically guided drain placement.
4. Antegrade nephrostogram.
Complications: None.
Medications: 1 mg Versed and 50 mcg fentanyl IV.
Technique: After the risks, benefits and alternatives were explained to the patient and written, informed consent was obtained, the patient was placed prone on the fluoroscopic table. The left back and flank were prepped and draped in sterile fashion and 1% lidocaine was used for local anesthesia. With ultrasonographic control the posterior calyx of the left kidney was accessed with an 21-gauge needle and then an 018 inch wire was placed. The needle was exchanged for the Accustick system and contrast was instilled to
confirm position
. Over the wire exchange was then made for 6 French fascial dilator and then an 8 French percutaneous nephrostomy tube. Final position was confirmed with spot fluoroscopy. Antegrade nephrostogram was performed. Catheter was secured to the skin at the exit site with 2-0 silk suture. There were no complications and the patient tolerated the procedure well. Findings: 1. Minimal-moderate hydronephrosis left kidney. A permanent image was obtained and stored.
2. Ultrasound guided percutaneous access to left renal collecting system via a midpole calyx.
3. Fluoroscopically guided 8 French percutaneous nephrostomy tube placement with pigtail in the renal pelvis. Permanent image stored in the digital picture archive.
4. Antegrade nephrostogram demonstrates moderate hydronephrosis and proximal hydroureter left kidney.
Impression: Successful left percutaneous nephrostomy tube placement with ultrasound and fluoroscopic guidance.