Wiki PCNL with antegrade neprhostogram

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TnRushFan

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Good morning everyone,

Pt had nephrostomy tube placed by radiology...then went later to OR - surgeon performed tract dilation, stone removal, stent placement and antegrade nephrostogram, catheter left in place. Does anyone know if the antegrade imaging / interpretation is bundled into the PCNL?

50081 [greater than 2cm]
50431 contrast for nephrostogram ? ?
74425 antegrade imaging ? ?
dilation bundles
stent bundles

Thank you for your thoughts.
 
maybe this will help-
CPT- 50431- existing access -
Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation
Coding Tip:
Do not report 50430-50431 with 50432–50435, 50693–50695, or 74425 for the same renal collection system and/or associated ureter. These codes are diagnostic services that include injection of contrast material, all associated radiological supervision and interpretation, and procedural imaging guidance (i.e., fluoroscopy, ultrasound, etc.). Code 50430 includes accessing the collecting system and/or associated ureter with a needle or catheter.
 
I would suggest the following coding for your clinical scenario:
50081 for the PCNL, and
50435 for the change of the NT. This code also includes the nephrostogram performance and interpretation.
Michael A. Ferragamo MD, FACS
 
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