Looking to me like 52332 & 52315 are bundled. Can the stent removal be billed separately due to fragmentation of encrusted stent?
A cystoscope with a 22.5 French sheath and a 30° lens was atraumatically advanced into the urethra and into the bladder. A ureteral stent was found emanating from the leftureteral orifice. The stent was noted to be encrusted and required fragmentation of the encrustations utilizing rigid graspers. Once encrustations were successfully removed, the stent was then subsequently grasped utilizing graspers and pulled out externally to the urethral meatus. With the stent in this position a sensor guidewire was attempted to be cannulated through the stent. However, secondary to the encrustations this was not possible. As such, the entirety of the stent was removed. The cystoscope was reinserted and a sensor guidewire was cannulated up to the level of the left renal pelvis.
A dual-lumen catheter was advanced into the distal left ureter and retrograde pyelogram was performed. No filling defects were identified in the left ureter or left renal pelvis. There is no evidence of hydronephrosis of the left kidney. The dual-lumen catheter could not be advanced beyond the level of the distal ureter secondary to the patient's underlying stricture.
A 6 French by 26 cm ureteral stent was advanced over the sensor guidewire and the stent was placed under fluoroscopic guidance. Good curling was noted in the bladder and within the renal pelvis under under fluoroscopy.
A cystoscope with a 22.5 French sheath and a 30° lens was atraumatically advanced into the urethra and into the bladder. A ureteral stent was found emanating from the leftureteral orifice. The stent was noted to be encrusted and required fragmentation of the encrustations utilizing rigid graspers. Once encrustations were successfully removed, the stent was then subsequently grasped utilizing graspers and pulled out externally to the urethral meatus. With the stent in this position a sensor guidewire was attempted to be cannulated through the stent. However, secondary to the encrustations this was not possible. As such, the entirety of the stent was removed. The cystoscope was reinserted and a sensor guidewire was cannulated up to the level of the left renal pelvis.
A dual-lumen catheter was advanced into the distal left ureter and retrograde pyelogram was performed. No filling defects were identified in the left ureter or left renal pelvis. There is no evidence of hydronephrosis of the left kidney. The dual-lumen catheter could not be advanced beyond the level of the distal ureter secondary to the patient's underlying stricture.
A 6 French by 26 cm ureteral stent was advanced over the sensor guidewire and the stent was placed under fluoroscopic guidance. Good curling was noted in the bladder and within the renal pelvis under under fluoroscopy.