Wiki Cystoscopy with fulguration of active bleeder at the 2 o'clock position on the bladder neck. Clot evacuation. Cystolitholapaxy

[Miko24]

PROCEDURE NOTE: As follows: After obtaining informed consent, the patient was
brought to the operative suite where he was prepped and draped in the usual
sterile fashion in the dorsal lithotomy position on the operating table after
successful induction of anesthesia and periprocedural antibiotics.


Resectoscope sheath was inserted into the patient's bladder with the visual obturator in place. The bladder was entered atraumatically. There were
multiple stones within the bladder measuring as large as 3 cm. There were a tleast 5 stones in the bladder. There was also a significant amount of clot in
the bladder. The clot was evacuated, leaving about 75 mL of clot removed from the bladder. An active bleeder was then located at the 2 o'clock position on
the bladder neck. This was fulgurated in its entirety. With this complete, there was no significant bleeding appreciated. A 1000-micron laser fiber was
then used to attempt to fragment the stones within the bladder. This was only partially successful. Three laser fibers were used and shoot through without
successfully removing any of the bladder calculi from within the bladder. These stones were very hard and very large and proved too much for the 1000-micron
laser fibers. Therefore, the patient's bladder was again evacuated and inspection of the bladder and bladder neck revealed no further bleeding.
Therefore, the resectoscope was removed and a 20-French Coude catheter was inserted into the patient's bladder atraumatically. The balloon was inflated to
10 mL and the catheter was placed to gravity drainage to conclude the procedure.

I billed 52214 and 52318 and they denied 52214

 

[svt96cobra]

PROCEDURE NOTE: As follows: After obtaining informed consent, the patient was
brought to the operative suite where he was prepped and draped in the usual
sterile fashion in the dorsal lithotomy position on the operating table after
successful induction of anesthesia and periprocedural antibiotics.


Resectoscope sheath was inserted into the patient's bladder with the visual obturator in place. The bladder was entered atraumatically. There were
multiple stones within the bladder measuring as large as 3 cm. There were a tleast 5 stones in the bladder. There was also a significant amount of clot in
the bladder. The clot was evacuated, leaving about 75 mL of clot removed from the bladder. An active bleeder was then located at the 2 o'clock position on
the bladder neck. This was fulgurated in its entirety. With this complete, there was no significant bleeding appreciated. A 1000-micron laser fiber was
then used to attempt to fragment the stones within the bladder. This was only partially successful. Three laser fibers were used and shoot through without
successfully removing any of the bladder calculi from within the bladder. These stones were very hard and very large and proved too much for the 1000-micron
laser fibers. Therefore, the patient's bladder was again evacuated and inspection of the bladder and bladder neck revealed no further bleeding.
Therefore, the resectoscope was removed and a 20-French Coude catheter was inserted into the patient's bladder atraumatically. The balloon was inflated to
10 mL and the catheter was placed to gravity drainage to conclude the procedure.

I billed 52214 and 52318 and they denied 52214

If it is a commercial insurance carrier, they may require a 59 (or XS, XU, XE) on the 52214. Even though they are not "bundled" by NCCI, the individual carrier may require the modifier on the additional procedure code.