lcole7465
Expert
So I have a provider that is billing 52005-RT, 52005-59-LT, 51741-26 and 51797-26. I know 51797 is an add-on code and can only be billed with 51728 or 51729. Can the surgeon code 51797-26 by itself. Urodynamics were
performed about 2 weeks prior to the procedure. Below is a pertinent part of the op report:
PREOPERATIVE DIAGNOSIS: Urinary incontinence, pelvic prolapse.
*
POSTOPERATIVE DIAGNOSIS: Urethral hypermobility, objective
stress incontinence, POP-Q stage I, anteroposterior compartment
prolapse.
*
OPERATION PERFORMED: Cystoscopy, bilateral retrograde
pyelograms, and urodynamics.
*
CLINICAL NOTE: The patient is a female, para 2
status post one C-section, one vaginal delivery, birth weight up
to 8 pounds, status post vaginal hysterectomy for uterine
prolapse status post laparoscopic cholecystectomy, who was seen
for evaluation of microhematuria, stress incontinence as well as
symptoms of difficulty emptying. She does describe some vaginal
bulging and denies any dyspareunia.
*
The patient was seen by urogynecologist in the past. The patient
recently was diagnosed with a thyroid abnormality and underwent a
total thyroidectomy. Since undergoing thyroid surgery, she has
gained 20 pounds and has had intermittent issues with
constipation as well as irritable bowel symptoms. CT scan from
April 2017 demonstrated no gross upper tract abnormalities. The
patient does describe stress incontinence requiring up to two
pads per day. She does describe intermittent problems with
difficulty and emptying her bladder.
*
Urologic evaluation included renal ultrasound demonstrating
normal upper tract studies.
*
She did undergo video urodynamics today in the office. On an
initial noninvasive uroflow she with a maximum flow of 19.3
mL/sec, voided volume of 23, postvoid residual 5 mL. Her flow
voided volume was only 23.7 mL. Therefore, flow morphology was
nonspecific.
*
Cystometrogram for sensation 125.3, urgency at 348, maximum
bladder capacity of 556. During the filling phase of her
cystometrogram her intravesical pressures remained low without
any instability. The patient was noted to have multiple episodes
of urinary incontinence seen at 150, 203, 300, 504 mL. A
Valsalva leak point pressure measured 150 mL was positive at an
intraabdominal pressure of 164. Pressure flow study maximum
detrusor pressure of 43.2 cm of water. Maximum flow 13.1 mL,
postvoid residual only 13 mL. On the video phase of her study
she was noted to have evidence of poor urethral coaptation.
There was evidence of a slight cystocele.
*
The patient was then brought to the operating room and placed in
the dorsal lithotomy position. She was prepped and draped under
the usual sterile technique. A 22-French cystoscope was used to
evaluate the patient. The anterior urethra was normal in
appearance without any evidence of stricture. Upon entering the
bladder both ureteral orifices were identified, appeared to be in
orthotopic position, with clear efflux urine. Systematic
evaluation of bladder with a 30 and 70-degree angle lens
demonstrated no gross intravesical pathology specifically no
gross inflammation, tumor, or calculi.
*
A 5-French end-hole catheter was placed in the right ureteral
orifice. A right retrograde pyelogram under real-time
fluoroscopy demonstrated no gross static filling defect or
obstructive uropathy. Subsequently, a left retrograde pyelogram
was performed. This demonstrated no gross static filling defect
or obstructive uropathy. At this point, then the bladder was
filled to capacity. The cystoscope was withdrawn. On pelvic
examination, she was noted to have urethral hypermobility, POP-Q
stage I, anteroposterior compartment prolapse. There appeared to
be she has had previous hysterectomy, good support of the vaginal
wall.
*
IMPRESSION:
1. Stress urinary incontinence.
2. POP-Q stage I, anteroposterior compartment prolapse.
*
DECISION MAKING: At this time, I do feel that she would benefit
from a mid urethral synthetic sling. We will arrange for
gynecologic evaluation for consideration of anteroposterior
colporrhaphy. The patient will be discharged home on Duricef x72
hours. Update appointment in 4-6 weeks.
performed about 2 weeks prior to the procedure. Below is a pertinent part of the op report:
PREOPERATIVE DIAGNOSIS: Urinary incontinence, pelvic prolapse.
*
POSTOPERATIVE DIAGNOSIS: Urethral hypermobility, objective
stress incontinence, POP-Q stage I, anteroposterior compartment
prolapse.
*
OPERATION PERFORMED: Cystoscopy, bilateral retrograde
pyelograms, and urodynamics.
*
CLINICAL NOTE: The patient is a female, para 2
status post one C-section, one vaginal delivery, birth weight up
to 8 pounds, status post vaginal hysterectomy for uterine
prolapse status post laparoscopic cholecystectomy, who was seen
for evaluation of microhematuria, stress incontinence as well as
symptoms of difficulty emptying. She does describe some vaginal
bulging and denies any dyspareunia.
*
The patient was seen by urogynecologist in the past. The patient
recently was diagnosed with a thyroid abnormality and underwent a
total thyroidectomy. Since undergoing thyroid surgery, she has
gained 20 pounds and has had intermittent issues with
constipation as well as irritable bowel symptoms. CT scan from
April 2017 demonstrated no gross upper tract abnormalities. The
patient does describe stress incontinence requiring up to two
pads per day. She does describe intermittent problems with
difficulty and emptying her bladder.
*
Urologic evaluation included renal ultrasound demonstrating
normal upper tract studies.
*
She did undergo video urodynamics today in the office. On an
initial noninvasive uroflow she with a maximum flow of 19.3
mL/sec, voided volume of 23, postvoid residual 5 mL. Her flow
voided volume was only 23.7 mL. Therefore, flow morphology was
nonspecific.
*
Cystometrogram for sensation 125.3, urgency at 348, maximum
bladder capacity of 556. During the filling phase of her
cystometrogram her intravesical pressures remained low without
any instability. The patient was noted to have multiple episodes
of urinary incontinence seen at 150, 203, 300, 504 mL. A
Valsalva leak point pressure measured 150 mL was positive at an
intraabdominal pressure of 164. Pressure flow study maximum
detrusor pressure of 43.2 cm of water. Maximum flow 13.1 mL,
postvoid residual only 13 mL. On the video phase of her study
she was noted to have evidence of poor urethral coaptation.
There was evidence of a slight cystocele.
*
The patient was then brought to the operating room and placed in
the dorsal lithotomy position. She was prepped and draped under
the usual sterile technique. A 22-French cystoscope was used to
evaluate the patient. The anterior urethra was normal in
appearance without any evidence of stricture. Upon entering the
bladder both ureteral orifices were identified, appeared to be in
orthotopic position, with clear efflux urine. Systematic
evaluation of bladder with a 30 and 70-degree angle lens
demonstrated no gross intravesical pathology specifically no
gross inflammation, tumor, or calculi.
*
A 5-French end-hole catheter was placed in the right ureteral
orifice. A right retrograde pyelogram under real-time
fluoroscopy demonstrated no gross static filling defect or
obstructive uropathy. Subsequently, a left retrograde pyelogram
was performed. This demonstrated no gross static filling defect
or obstructive uropathy. At this point, then the bladder was
filled to capacity. The cystoscope was withdrawn. On pelvic
examination, she was noted to have urethral hypermobility, POP-Q
stage I, anteroposterior compartment prolapse. There appeared to
be she has had previous hysterectomy, good support of the vaginal
wall.
*
IMPRESSION:
1. Stress urinary incontinence.
2. POP-Q stage I, anteroposterior compartment prolapse.
*
DECISION MAKING: At this time, I do feel that she would benefit
from a mid urethral synthetic sling. We will arrange for
gynecologic evaluation for consideration of anteroposterior
colporrhaphy. The patient will be discharged home on Duricef x72
hours. Update appointment in 4-6 weeks.