Miko24
Guru
The patient has had a radical prostatectomy and the previous op note stated urethrovesical anastomosis was performed using a double-armed 3-0 V-lock suture. This was a running stitch starting posterior on the bladder neck and finishing anterior on the bladder neck.
Patient now has a bladder neck contracture
The urethral meatus is sounded to 28 French with van Buren sounds. A 22 French DVIU scope with zero degree lens is inserted through the urethra and advanced to the level of the bladder neck. A bladder neck contracture is identified. A cold knife was used to incise the contracture at the 4 o'clock and 8 o'clock positions. The mucosa and underlying scar tissue are incised. The contracture opens well at this point. I am able to pass the scope through the bladder neck into the bladder. The bladder is surveyed and found to be normal. The scope was then slowly removed from the urethra after insertion of a guidewire. Heymann dilators are then used to dilate the contracture. I dilated sequentially from 20fr to 24 fr.
A 16 French council tip Foley catheter was then placed over the guidewire without difficulty. The balloon is inflated with 10 cc of normal saline. This is the end of the procedure.
I am thinking a couple of codes: 52450-52, 52500-52 or an unlisted code of 53899 benchmarked to 52640?
Thank you
Patient now has a bladder neck contracture
The urethral meatus is sounded to 28 French with van Buren sounds. A 22 French DVIU scope with zero degree lens is inserted through the urethra and advanced to the level of the bladder neck. A bladder neck contracture is identified. A cold knife was used to incise the contracture at the 4 o'clock and 8 o'clock positions. The mucosa and underlying scar tissue are incised. The contracture opens well at this point. I am able to pass the scope through the bladder neck into the bladder. The bladder is surveyed and found to be normal. The scope was then slowly removed from the urethra after insertion of a guidewire. Heymann dilators are then used to dilate the contracture. I dilated sequentially from 20fr to 24 fr.
A 16 French council tip Foley catheter was then placed over the guidewire without difficulty. The balloon is inflated with 10 cc of normal saline. This is the end of the procedure.
I am thinking a couple of codes: 52450-52, 52500-52 or an unlisted code of 53899 benchmarked to 52640?
Thank you