Wiki Ir nphrostogram, antegrade

[suela923@aol.com]

Left nephrostogram and nephrostomy tube removal

History: This is a 75-year old male who previously had placement of an internal/external nephroureteral catheter for obstructive uropathy due to a 3 mm calculus at the left ureterovesical junction. Last Friday the small calculus was pushed into the bladder from the distal ureter and a nephrostomy tube was placed as a safety device over the weekend. The nephrostomy tube was capped. According to the patient he has done well and has not had any significant flank pain. He returns today for catheter removal.

Timeout procedure performed. The previously placed nephrostomy catheter was injected with contrast and a nephrostogram was performed. There was no hydronephrosis. The intrarenal collecting system looked normal. There was a filling defect in the distal ureter at the mid to lower sacral level consistent with a small clot. This was nonobstructive. Contrast did flow passed into the bladder. The clot was flushed from the ureter using approximately 20 cc of saline. Following this there was no residual thrombus in the ureter. Contrast flowed freely from the kidney into the bladder.

Previously placed left nephrostomy tube was removed over a guidewire using fluoroscopice guidance.

We billed as 50394, 74425 but I am wondering why 50389 wouldn't be used. Does there have to be a concurrent indwelling ureteral stent or could this code be used for a removal of a nephrostomy tube by itself?

Thank you!

 

[jtuominen]

50389 is only used for non routine, complicated nephrostomy tube removals. The most common example is the one listed right in the code definition that reads "ie. with concurrent indwelling ureteral stent". So typically in the situation that would allow you to bill 50389, you've got a patient with a nephrostomy tube in place and a ureteral stent, and you need to use flurosocopy to successfully remove the nephrostomy tube without damaging the ureteral stent that is in place. If you got hung up on that while removing the nephrostomy tube, that would be a bad time. Probably have to have the patient come back in for a replacement asap. Also note that when you are going to go with 50389, you are probably not going to bill 50394/74425, unless there is medical indication (like the patient presents with some new symptom that needs to be further studied) in addition to the removal. You've got a CCI edit between 50394 and 50389 you will need to satisfy to show this necessity as well.

When the patient's neph tube is planned to be removed, and there are no real complicating factors that you see in the note, and it just reads like a routine removal, the only thing you should really bill for is 50394 and 74425.

On top of it your provider's note really does a nice job of supporting 50394/74425, because they give us a interpretation of the contrast flowing through the entire renal collecting system, all the way down to the bladder, so bravo on that one.

 

[suela923@aol.com]

Thanks!!