Wiki Antegrade Ureteroscopy w/ laser incision of ureteral stricture?

[toria11]

Hi everyone. I can't find a good code for this, I was hoping someone could help. Patient has a left ureteral ileal anastomotic stricture.

Findings: Antegrade ureteroscopy revealed a tight stricture with inability to place a guidewire into the ileal conduit. Holmium laser incision of the stricture resulted inperforation of the ureter. PAtient was subsequently turned to supine position and endoscopy of the ileal conduit with guidewire placement past the stricture was successful. The stricture was dilated to 15 French.

The exisitng nephrostomy tube was removed and discarded. The flexible ureteroscope was then placed into the access sheath advanced distally under the stricture was identified. A guidwire was attempted to be advanced past the stricture but this failed. Subsequently the stricture was incised using a holmium laser. Unfortunately the ureter was perforated and a guidewire could not be advanced into the ileal conduit. Decision was made to go retrogradely.

Then a cystoscope was used, the ileal tortuosity was straightened, and the stricture was dilated using a balloon which I know would be coded with 52344, but what about the antegrade incision with the laser?

Thanks!

 

[daniel]

Antegrade ureteroscopy Holmium laser incision of the stricture, I'd use 50557. I don't like 50957, so not an exact fit. But 50557 is antegrade, but usually done through through established nephrostomy or pyelostomy. You retrograde code 52344 if the right range.

Hope this helps.

 

[toria11]

Antegrade ureteroscopy Holmium laser incision of the stricture, I'd use 50557. I don't like 50957, so not an exact fit. But 50557 is antegrade, but usually done through through established nephrostomy or pyelostomy. You retrograde code 52344 if the right range.

Hope this helps.

This helps a lot actually, thank you so much! I think 50557 is the best fit too.