suela923@aol.com
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Can I bill for both a nephrostogram and a ureterogram in this case? THANKS!
Left-sided antegrade pyelogram, ureterogram, and internal/external percutaneous nephroureteral catheter placement.
History: Left-sided staghorn calculus with flank pain.
Technique: Timeout was performed. Patient was placed prone on the fluoroscopy table, and the left flank was prepped and draped sterilely, 2% lidocaine was used as a local anesthetic. Moderate sedation was also administered. Under fluoroscopic guidance, a 22-gauge needle was advanced into the lower pole infundibulum, and antegrade pyelogram was performed. Wire was advanced under fluoroscopic guidance to the ureter, and exchange catheter was placed. Catheter was advanced into the ureter, and a ureterogram was performed. Over a wire and after the tract was dilated, a 10-French dual-lumen catheter was advanced into the bladder. Final KUB was performed. Patient tolerated the procedure well with no complications.
Findings: Scout x-ray shows staghorn calculus left kidney.
Antegrade pyelogram shows access into dilated lower pole calyx and infundibulum. The staghorn calculus is seen centrally. The ureter is faintly opacified. Needle is in excellent position for access.
Ureterogram shows an ovoid filling defect in the proximal ureter, likely a blood clot and/or air bubble. Staghorn calculus is unchanged in position. Catheter is in excellent location.
Final x-ray shows 10-French dual-lumen catheter in excellent position, the distal aspect in the bladder and the proximal aspect coursing through the lower pole calyx.
Left-sided antegrade pyelogram, ureterogram, and internal/external percutaneous nephroureteral catheter placement.
History: Left-sided staghorn calculus with flank pain.
Technique: Timeout was performed. Patient was placed prone on the fluoroscopy table, and the left flank was prepped and draped sterilely, 2% lidocaine was used as a local anesthetic. Moderate sedation was also administered. Under fluoroscopic guidance, a 22-gauge needle was advanced into the lower pole infundibulum, and antegrade pyelogram was performed. Wire was advanced under fluoroscopic guidance to the ureter, and exchange catheter was placed. Catheter was advanced into the ureter, and a ureterogram was performed. Over a wire and after the tract was dilated, a 10-French dual-lumen catheter was advanced into the bladder. Final KUB was performed. Patient tolerated the procedure well with no complications.
Findings: Scout x-ray shows staghorn calculus left kidney.
Antegrade pyelogram shows access into dilated lower pole calyx and infundibulum. The staghorn calculus is seen centrally. The ureter is faintly opacified. Needle is in excellent position for access.
Ureterogram shows an ovoid filling defect in the proximal ureter, likely a blood clot and/or air bubble. Staghorn calculus is unchanged in position. Catheter is in excellent location.
Final x-ray shows 10-French dual-lumen catheter in excellent position, the distal aspect in the bladder and the proximal aspect coursing through the lower pole calyx.