What CPT code do you use for a transabdominal percutaneous puncture of a Foley balloon? See report below
INDICATION: Malfunctioning Foley catheter, balloon will not deflate, retained foreign body
COMPARISON: Ultrasound performed 2/13/2021
PROCEDURE: 1. Initiation of moderate conscious sedation 2. Cannulization of malfunctioning indwelling Foley catheter (balloon port) 3. Hand injected cystogram via indwelling Foley catheter 4. Ultrasound-guided puncture of persistently inflated Foley balloon 5. Successful removal of Foley balloon and catheter in their entirety
REPORT: The patient is a 35-year-old male admitted for multiple medical conditions including pneumonia. It was noted on 2/12/2021 that the Foley catheter that was currently indwelling would not deflate the balloon. Urology tried several strategies including removal of the valve, cannulization of the balloon port with a wire, and the injection of mineral oil. These were unsuccessful. Risks and benefits of catheter manipulation as well as percutaneous bladder puncture were discussed with the patient. This included bleeding and infection. After obtaining informed consent from the patient was brought to angiography and placed in a supine position. The anterior pelvic wall, genitals, and indwelling Foley catheter were all prepped and draped using standard sterile technique. The procedural area was marked by the radiologist and a timeout was performed. Moderate IV sedation was initiated utilizing a combination of fentanyl and Versed. Supplemental oxygen was provided by nasal cannula. Sedation was taken to a moderate level of maintained for approximately 31 minutes. A small amount of contrast was injected through the balloon port of the Foley catheter without opacifying the balloon. Instead, contrast was identified within the urethra as well as the bladder indicating that there was a communication proximal to the obstruction or blockage between the balloon port and the functional lumen of the Foley catheter. A 035 Glidewire was advanced through the balloon port. The angled portion of the wire was insufficient to report the balloon and the stiff portion of the wire was insufficient to navigate the tract particularly at the level of the prostatic urethra. At this point further attempts to puncture the balloon from an internal approach were terminated. Using ultrasound guidance a trajectory from the skin surface to the balloon was identified just above the level of the pubic symphysis. The tract was anesthetized utilizing 1% lidocaine. Then using ultrasound guidance a 22-gauge 3.5" spinal needle was advanced into the bladder. The balloon was still slightly mobile so dynamic ultrasound guidance was utilized to square up on the balloon and a puncture in its central aspect. The balloon deflated immediately. The needle was removed. Repeat imaging demonstrated no evidence of hemorrhage or other complication associated with bladder puncture. The Foley catheter and the balloon were both removed in their entireties. A bandage was placed over the puncture site and the patient was transferred back to his hospital room.
Impression: 1. Contrast injected portogram demonstrating distally occluded balloon port. 2. Failed attempts at advancing a 035 Glidewire into the balloon. 3. Successful percutaneous puncture of balloon with a 22-gauge spinal needle. 4. Balloon and catheter both removed in their entirety.
INDICATION: Malfunctioning Foley catheter, balloon will not deflate, retained foreign body
COMPARISON: Ultrasound performed 2/13/2021
PROCEDURE: 1. Initiation of moderate conscious sedation 2. Cannulization of malfunctioning indwelling Foley catheter (balloon port) 3. Hand injected cystogram via indwelling Foley catheter 4. Ultrasound-guided puncture of persistently inflated Foley balloon 5. Successful removal of Foley balloon and catheter in their entirety
REPORT: The patient is a 35-year-old male admitted for multiple medical conditions including pneumonia. It was noted on 2/12/2021 that the Foley catheter that was currently indwelling would not deflate the balloon. Urology tried several strategies including removal of the valve, cannulization of the balloon port with a wire, and the injection of mineral oil. These were unsuccessful. Risks and benefits of catheter manipulation as well as percutaneous bladder puncture were discussed with the patient. This included bleeding and infection. After obtaining informed consent from the patient was brought to angiography and placed in a supine position. The anterior pelvic wall, genitals, and indwelling Foley catheter were all prepped and draped using standard sterile technique. The procedural area was marked by the radiologist and a timeout was performed. Moderate IV sedation was initiated utilizing a combination of fentanyl and Versed. Supplemental oxygen was provided by nasal cannula. Sedation was taken to a moderate level of maintained for approximately 31 minutes. A small amount of contrast was injected through the balloon port of the Foley catheter without opacifying the balloon. Instead, contrast was identified within the urethra as well as the bladder indicating that there was a communication proximal to the obstruction or blockage between the balloon port and the functional lumen of the Foley catheter. A 035 Glidewire was advanced through the balloon port. The angled portion of the wire was insufficient to report the balloon and the stiff portion of the wire was insufficient to navigate the tract particularly at the level of the prostatic urethra. At this point further attempts to puncture the balloon from an internal approach were terminated. Using ultrasound guidance a trajectory from the skin surface to the balloon was identified just above the level of the pubic symphysis. The tract was anesthetized utilizing 1% lidocaine. Then using ultrasound guidance a 22-gauge 3.5" spinal needle was advanced into the bladder. The balloon was still slightly mobile so dynamic ultrasound guidance was utilized to square up on the balloon and a puncture in its central aspect. The balloon deflated immediately. The needle was removed. Repeat imaging demonstrated no evidence of hemorrhage or other complication associated with bladder puncture. The Foley catheter and the balloon were both removed in their entireties. A bandage was placed over the puncture site and the patient was transferred back to his hospital room.
Impression: 1. Contrast injected portogram demonstrating distally occluded balloon port. 2. Failed attempts at advancing a 035 Glidewire into the balloon. 3. Successful percutaneous puncture of balloon with a 22-gauge spinal needle. 4. Balloon and catheter both removed in their entirety.