WonderCoder
Contributor
Could someone please help me?
Op note
With patient prone, the left flank region was prepped and draped in a sterile manner. The kidney was localized sonographically and fluoroscopically. Under US guidance, a 22 gauge needle was advanced into the renal collecting system. However, due to the nondilated state of the collecting system, contrast kept extravasting into the adjacent renal parenchyma. Therefore under US and fluoroscopic guidance, a separate 22 gauge needle was employed to impact the large calculus in the upper portion of the left kidney. I eas then able to slide the tip of the needle to the edge of this calculus. Injecting contrast at this point did opacify and distend the renal collecting system with continuous infusion of dilute contrast to keep the collecting system distended, the lower pole calix, containing the smaller calculus, was punctured under Fluoro guidance. Using standard over the wire technique, the needle was replaced with the 6 french access catheter. An 0.035 angled glidewire and an Amplatz extra stiff wire were employed to access the bladder and insert the 5 french OF catheter. The 5 French catheter was positioned with its tip withing the bladder. Completion imaging was obtained documenting the catheter position.
What was Coded
CPT 50393, 50390 (59), 74480 (26), 74425 (26)
Correct or not? Insurance is stating they will not pay the 50390. In what case would it be ok to bill the 50390 and 50393 together?
Thank you
Op note
With patient prone, the left flank region was prepped and draped in a sterile manner. The kidney was localized sonographically and fluoroscopically. Under US guidance, a 22 gauge needle was advanced into the renal collecting system. However, due to the nondilated state of the collecting system, contrast kept extravasting into the adjacent renal parenchyma. Therefore under US and fluoroscopic guidance, a separate 22 gauge needle was employed to impact the large calculus in the upper portion of the left kidney. I eas then able to slide the tip of the needle to the edge of this calculus. Injecting contrast at this point did opacify and distend the renal collecting system with continuous infusion of dilute contrast to keep the collecting system distended, the lower pole calix, containing the smaller calculus, was punctured under Fluoro guidance. Using standard over the wire technique, the needle was replaced with the 6 french access catheter. An 0.035 angled glidewire and an Amplatz extra stiff wire were employed to access the bladder and insert the 5 french OF catheter. The 5 French catheter was positioned with its tip withing the bladder. Completion imaging was obtained documenting the catheter position.
What was Coded
CPT 50393, 50390 (59), 74480 (26), 74425 (26)
Correct or not? Insurance is stating they will not pay the 50390. In what case would it be ok to bill the 50390 and 50393 together?
Thank you
