In a case like this when both urethral dilation and catheter placement is performed, is it most correct to bill for the dilation or for a complex catheter placement? I always question myself when choosing which to bill. Thanks!!
POSTOPERATIVE DIAGNOSIS:
Urethral stricture disease.
PROCEDURE PERFORMED:
Complex cystoscopy with urethral dilatation, and catheterization.
ANESTHESIA:
General.
DESCRIPTION OF PROCEDURE:
This 69-year-old gentleman and was asleep on the table in preparation to undergo open heart surgery when the operating room team had difficulty accessing the gentleman's bladder through the urethra, so our service was consulted on an emergent basis. I do not have much in the way of historical urologic detail on the gentleman. We do not believe that he was a member of our practice prior to this event. In any event, upon entry into the operating room, the gentleman was asleep on the table. His urethra was then prepped and draped in a sterile fashion and a flexible cystoscope was passed. I used a multitude of wires to try to figure out, which little channel had continuity with the bladder and I was able to advance a guidewire through one of these on into the bladder. I then used the Bard-Heyman obstructed urethral dilatation kit utilizing the woven followers over the guidewire on into the bladder up to about an 18-French. I then utilized the 14-French Council tip catheter that comes with the kit over the rigid guide and advanced that over the guidewire and into the gentleman's bladder wall. We were then able to inflate that with 10 mL. I removed the guidewire and the guide itself, and clear urine was returned.
POSTOPERATIVE DIAGNOSIS:
Urethral stricture disease.
PROCEDURE PERFORMED:
Complex cystoscopy with urethral dilatation, and catheterization.
ANESTHESIA:
General.
DESCRIPTION OF PROCEDURE:
This 69-year-old gentleman and was asleep on the table in preparation to undergo open heart surgery when the operating room team had difficulty accessing the gentleman's bladder through the urethra, so our service was consulted on an emergent basis. I do not have much in the way of historical urologic detail on the gentleman. We do not believe that he was a member of our practice prior to this event. In any event, upon entry into the operating room, the gentleman was asleep on the table. His urethra was then prepped and draped in a sterile fashion and a flexible cystoscope was passed. I used a multitude of wires to try to figure out, which little channel had continuity with the bladder and I was able to advance a guidewire through one of these on into the bladder. I then used the Bard-Heyman obstructed urethral dilatation kit utilizing the woven followers over the guidewire on into the bladder up to about an 18-French. I then utilized the 14-French Council tip catheter that comes with the kit over the rigid guide and advanced that over the guidewire and into the gentleman's bladder wall. We were then able to inflate that with 10 mL. I removed the guidewire and the guide itself, and clear urine was returned.