Ask Dr. Z

Patient returned for a routine exchange of a modified nephroureteral stent. The distal aspect of the catheter terminates in the distal ureter instead of the bladder. Should CPT 50435 or 50387 be coded? "Spot fluoroscopic image of the catheter demonstrated to be well-positioned within the renal collecting system. The catheter was pulled back by 2 cm. A small amount contrast was injected through the catheter confirming appropriate positioning and demonstrating slight improvement in left hydroureteronephrosis since the prior study. The catheter was cut and removed over a guidewire and exchanged for an identical 8 French modified nephroureteral stent, the distal aspect of which sits in the distal left ureter. The proximal locking loop was formed under direct fluoroscopy in the renal pelvis. A small amount of contrast was injected confirming appropriate positioning. Uncomplicated exchange of an 8.5 French modified nephroureteral stent for identical catheter."