lschaffer
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Can someone tell me if there is a code for laser infundibulotomy? The patient had cysto, laser lithotripsy, laser infundibulotomy and ureteral stent. I think I can code the 52356 but not sure if the laser infundibulotomy is separately billable or inlcuded?
.....The tortuous urethra was negotiated with a 20-French cystoscope revealing a previous urethral stricture to be dilated and the prostate to be nonobstructing. The bladder mucosa was normal other than expected inflammatory stent changes around the left ureteral orifice. The indwelling left ureteral stent was exchanged for a Glidewire, upon which a 10-French dual-lumen catheter was backloaded and advanced into the left upper ureter under fluoroscopic guidance. Ten mL of one-half strength contrast was injected demonstrating the calculus to be in a calyceal diverticulum at the distal end of a narrow 2-cm infundibulum. A second Glidewire was advanced through the dual-lumen catheter and the dual-lumen catheter was removed. Both wires were maintained. A 7-French flexible ureteroscope was advanced into the left kidney. Using working wire, I was able to access the caliceal diverticulum and advanced the ureteroscope into the caliceal diverticulum over the wire. Due to the narrow infundibulum, a laser infundibulomy was performed using 6.4 watts to improve exposure of the stone. The dark brown, black 13-mm calculus was then fragmented using direct vision holmium laser lithotripsy to 200 micron fiber with power ranges of 6.4 up to 10 watts.............(report goes on stating he placed the double-J stent)
Any help would be appreciated.
Thanks,
Lori
.....The tortuous urethra was negotiated with a 20-French cystoscope revealing a previous urethral stricture to be dilated and the prostate to be nonobstructing. The bladder mucosa was normal other than expected inflammatory stent changes around the left ureteral orifice. The indwelling left ureteral stent was exchanged for a Glidewire, upon which a 10-French dual-lumen catheter was backloaded and advanced into the left upper ureter under fluoroscopic guidance. Ten mL of one-half strength contrast was injected demonstrating the calculus to be in a calyceal diverticulum at the distal end of a narrow 2-cm infundibulum. A second Glidewire was advanced through the dual-lumen catheter and the dual-lumen catheter was removed. Both wires were maintained. A 7-French flexible ureteroscope was advanced into the left kidney. Using working wire, I was able to access the caliceal diverticulum and advanced the ureteroscope into the caliceal diverticulum over the wire. Due to the narrow infundibulum, a laser infundibulomy was performed using 6.4 watts to improve exposure of the stone. The dark brown, black 13-mm calculus was then fragmented using direct vision holmium laser lithotripsy to 200 micron fiber with power ranges of 6.4 up to 10 watts.............(report goes on stating he placed the double-J stent)
Any help would be appreciated.
Thanks,
Lori