suela923@aol.com
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We had a patient come in for a bilateral nephrostomy tube change. We were only able to do the right side. On the left side an antegrade nephrostogram was performed but the doctor was unable to continue because of patient discomfort. Could we bill as 50398-74 or should we bill for an antegrade nephrostogram? My thinking is we attempted to do the tube change but were unable to due to patient discomfort so we should bill 50398-74. We would not normally bill for nephrostograms for tube changes so it appears to me like an uncompleted procedure. Any thoughts?!?!?!
Here is the report:
Bilateral antegrade nephrostogram, right-sided PCN exchange under fluoroscopic guidance.
History: Metastatic ovarian cancer with bilateral chronic indwelling percutaneous nephrostomy catheters. For routine check and change.
Technique: Time out was performed. Patient was placed prone on the fluoroscopy table and bilateral flanks were prepped and draped sterilely. 2% lidocaine was used as a local anesthetic. 100 mcg of IV fentanyl were also administered. The patient did not have transportation home so Versed could not be administered.
Right-sided antegrade nephrostogram was performed. The existing catheter was removed over a wire and a new 8-French PCN was placed into the renal pelvis. Completion nephrostogram was performed.
On the left, antegrade nephrostogram was performed. The patient refused to continue due to discomfort. She will be rescheduled for left-sided PCNU check and change.
Findings: Right-sided antegrade nephrostogram shows filling of the nondilated intrarenal collecting system and ureter. Contrast readily flows into the urinary bladder. PCN lies within a midpole calyx. New PCN was placed into the renal pelvis in excellent position. Locking loop courses into the infundibulum of the right upper pole. Again seen is a nondilated collecting system with prompt flow of contrast into the bladder.
Left-sided antegrade nephrostogram was performed showing a left-sided PCNU in satisfactory position. The ureter is occluded. There is minimal distention of the intrarenal collecting system however the patient refused to continue due to discomfort. The study was terminated. She will be rescheduled as an outpatient with moderate sedation.
Result Impression
Right-sided antegrade nephrostogram shows no evidence of occlusion. No obstruction. The right PCN was replaced and is capped. Should the patient tolerate this, it could be removed.
Left-sided PCNU in satisfactory position. Upon the patient's return, this will be checked and changed under moderate sedation.
Here is the report:
Bilateral antegrade nephrostogram, right-sided PCN exchange under fluoroscopic guidance.
History: Metastatic ovarian cancer with bilateral chronic indwelling percutaneous nephrostomy catheters. For routine check and change.
Technique: Time out was performed. Patient was placed prone on the fluoroscopy table and bilateral flanks were prepped and draped sterilely. 2% lidocaine was used as a local anesthetic. 100 mcg of IV fentanyl were also administered. The patient did not have transportation home so Versed could not be administered.
Right-sided antegrade nephrostogram was performed. The existing catheter was removed over a wire and a new 8-French PCN was placed into the renal pelvis. Completion nephrostogram was performed.
On the left, antegrade nephrostogram was performed. The patient refused to continue due to discomfort. She will be rescheduled for left-sided PCNU check and change.
Findings: Right-sided antegrade nephrostogram shows filling of the nondilated intrarenal collecting system and ureter. Contrast readily flows into the urinary bladder. PCN lies within a midpole calyx. New PCN was placed into the renal pelvis in excellent position. Locking loop courses into the infundibulum of the right upper pole. Again seen is a nondilated collecting system with prompt flow of contrast into the bladder.
Left-sided antegrade nephrostogram was performed showing a left-sided PCNU in satisfactory position. The ureter is occluded. There is minimal distention of the intrarenal collecting system however the patient refused to continue due to discomfort. The study was terminated. She will be rescheduled as an outpatient with moderate sedation.
Result Impression
Right-sided antegrade nephrostogram shows no evidence of occlusion. No obstruction. The right PCN was replaced and is capped. Should the patient tolerate this, it could be removed.
Left-sided PCNU in satisfactory position. Upon the patient's return, this will be checked and changed under moderate sedation.