Wiki PCNL?

[tori.a]

Hi! Is this a PCNL? I'm being thrown off by the wording and need a second opinion. 50080?

INDICATIONS FOR PROCEDURE: The patient previously presented with a
large left renal stone and underwent left percutaneous nephrolithotomy and presented today for a
second-look flexible nephroscopy with laser lithotripsy and stone basket. Risks, benefits, and alternatives
were reviewed, and agreed to proceed.
DETAILS OF PROCEDURE: The patient was brought to the operating room and placed on the table
in the supine position. After smooth induction of general anesthesia, he was placed in the prone positioning
and his percutaneous nephrotomy tube site and tube were prepped and draped in standard sterile fashion.
A guidewire was passed down through the Council tip nephrostomy tube and into the bladder. A flexible
cystoscope was then passed through the matured tract into the kidney. A large stone was identified. It
was grabbed and pulled out into the nephrotomy tube site where it got stuck about 1 inch from the skin. I
then went in with the laser and broke the stone up into the smaller pieces, which were then able to be
basketed out. I flushed out the rest of the kidney and looked around and did not see any other stones
fluoroscopically or visually. I then passed the flexible cystoscope all the way down the dilated ureter into
the bladder and flushed all the remaining stone fragments from the proximal ureter down into the bladder.
I did never no injuries to the ureter and so I did not feel a stent was indicated. At the end of the case, his
bladder was drained with the Foley catheter and dry dressings were placed on the nephrostomy tube site.
The patient was awakened from anesthesia, extubated, and brought to the recovery room in stable
condition having tolerated the procedure well. No complications. Minimal blood loss.

 

[Legacy79]

I am thinking this is 52353

 

[sxcoder1]

Seems like PCNL 50080 to me because it's through the nephrostomy tube.

 

[Legacy79]

Since this the patient already underwent left percutaneous nephrolithotomy previously, and there is no stab incision made in this session, my thinking is the nephrolithotomy tube was used as an access site in this operative session. But I am interested to know if this is still considered 50080 regardless.

 

[tori.a]

I'm still torn-- The patient's access is "mature" and no incision or dilation was necessary to access the stone. Normally I think this would be 50561 but with the use of the laser I'm so thrown off.

 

[daniel]

50561 (ureter), 50557 (kidney). I know it’s not a lesion for 50557. But think it fits. Plus Medicare lets you use both.


When multiple endoscopic procedures are performed at the same patient encounter, the most comprehensive code accurately describing the service(s) performed shall
be reported. If several procedures not included in a more comprehensive code are performed at the same endoscopic session, multiple HCPCS/CPT codes may be reported with modifier 51. (For example, if renal endoscopy is performed through an established nephrostomy with biopsy, fulguration of a lesion, and foreign body (calculus) removal, the appropriate CPT coding would be CPT codes 50557 and 50561-51, not CPT codes 50551, 50555, 50557, and 50561.) This policy applies to all endoscopic procedures, not only those of the genitourinary system.