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On this op report "A rigid cystoscope was used to intubate the meatus. The urethra appeared normal. Once within the bladder, the ureteral orifices were seen in orthotopic position. There were no concerning mucosal lesions. A stent was protruding from the left ureteral orifice. The stent was grasped with flexible grasper and brought to the meatus. A wire was inserted through the stent into the renal pelvis, and the stent removed intact. A flexible ureterscope was then assembled and advanced into the ureter alongside the wire. The holmium laster with 200 um fiber was used to fragment the calculus. Given the very large size of the calculus, this took some time. Visualization was very difficult due to the stone fragments floating throughout the kidney. Once I was convinced both endoscopically and radiographically that the stone was sufficiently fragmented, nephroscopy was performed. There was a 3 mm calculus in the interpolar region of the kidney. This was dusted with the holmium laser. In the lower pole there were 2 calculi equaling approximately 6 mm. Both calculi were laser fragmented. 2 large fragments remained at that time and the 0 tip basket was used to retrieve both of these fragments. The fragments were sent for chemical analysis. The uretersocope was slowly withdrawn and no other calculi were seen in the ureter. The ureter was very dilated from the previously placed ureteral stent, and I elected not to place a new stent.
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How would you code this +modifier?
Your opinion is greatly appreciated.