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Nephroureteral stent with ileal conduit
Date: Jul 24, 2012
Question:
With the changes in the rules for coding nephroureteral stents earlier this year, I’m a bit confused though. In light of the recommended changes, I believe that I would code ( report below) the left side with CPT 50393 and 74480 even though it involves an ileal conduit. Correct?
The right side is where I’m a bit confused. This side also involves an ileal conduit. Is this now correctly coded with CPT 50398 and 75984? TIA for a timely response!
Reason For Exam
bilat convert perc neph convert to NU STENT PLMNT
Report
PROCEDURE: Bilateral nephroureteral stent placement
CLINICAL HISTORY: 61-year-old male with a history of bladder cancer with ileal conduit reconstruction. Hydronephrosis was subsequently diagnosed and bilateral nephrostomy tubes were placed. He now returns for internalization.
FLUOROSCOPY TIME: 14.7 minutes
TECHNICAL DESCRIPTION: The patient was placed in the prone position. The indwelling nephrostomy tube areas were prepped and draped in a sterile fashion. Initially, dilute contrast material was injected through each of the nephrostomy tubes.
The left-sided nephrostomy tube was removed over a guidewire. After advancing a guidewire through a hydrophilic catheter into the ileal conduit, an 8-French internal/external drainage catheter was advanced over the guidewire until the pigtail portion lay within the ileal conduit with proximal sideholes along the ureter. Contrast was injected to confirm position.
Attention was turned to the right-sided nephrostomy tube. Again, following infiltration of the soft tissues with 1% lidocaine, the nephrostomy tube was removed over a guidewire. Guidewire and catheter technique were used to traverse the anastomosis into the ileal conduit. However, the internal/external drainage catheter could not be advanced across the stenotic anastomosis. As a result, a 5-French pigtail catheter was advanced over the guidewire across the anastomosis and left with its pigtail portion within the ileal conduit. Over a separate guidewire, an 8-French nephrostomy tube was advanced and left with its pigtail portion in the dilated right renal pelvis. Contrast was injected to confirm position.
The catheters were flushed, fixed to the skin, and left attached to gravity drainage.
The patient tolerated the procedure well and there were no immediate complications. He was later transported back to his ward in stable condition.
DIAGNOSIS:
1. Successful internalization of the left percutaneous nephrostomy tube for an 8-French internal/external nephroureteral stent.
2. Although an internal/external stent could not be placed on the right side, a 5-French pigtail catheter was left across the right-sided anastomosis to the ileal conduit. In addition, an 8-French nephrostomy tube was left in the right renal pelvis.
3. A tight residual stenosis is noted at the right ureteral implantation anastomosis.
4. No definite stones were seen on this examination.
PLAN: The above findings were discussed with the referring team for operative planning
The right side is where I’m a bit confused. This side also involves an ileal conduit. Is this now correctly coded with CPT 50398 and 75984? TIA for a timely response!
Reason For Exam
bilat convert perc neph convert to NU STENT PLMNT
Report
PROCEDURE: Bilateral nephroureteral stent placement
CLINICAL HISTORY: 61-year-old male with a history of bladder cancer with ileal conduit reconstruction. Hydronephrosis was subsequently diagnosed and bilateral nephrostomy tubes were placed. He now returns for internalization.
FLUOROSCOPY TIME: 14.7 minutes
TECHNICAL DESCRIPTION: The patient was placed in the prone position. The indwelling nephrostomy tube areas were prepped and draped in a sterile fashion. Initially, dilute contrast material was injected through each of the nephrostomy tubes.
The left-sided nephrostomy tube was removed over a guidewire. After advancing a guidewire through a hydrophilic catheter into the ileal conduit, an 8-French internal/external drainage catheter was advanced over the guidewire until the pigtail portion lay within the ileal conduit with proximal sideholes along the ureter. Contrast was injected to confirm position.
Attention was turned to the right-sided nephrostomy tube. Again, following infiltration of the soft tissues with 1% lidocaine, the nephrostomy tube was removed over a guidewire. Guidewire and catheter technique were used to traverse the anastomosis into the ileal conduit. However, the internal/external drainage catheter could not be advanced across the stenotic anastomosis. As a result, a 5-French pigtail catheter was advanced over the guidewire across the anastomosis and left with its pigtail portion within the ileal conduit. Over a separate guidewire, an 8-French nephrostomy tube was advanced and left with its pigtail portion in the dilated right renal pelvis. Contrast was injected to confirm position.
The catheters were flushed, fixed to the skin, and left attached to gravity drainage.
The patient tolerated the procedure well and there were no immediate complications. He was later transported back to his ward in stable condition.
DIAGNOSIS:
1. Successful internalization of the left percutaneous nephrostomy tube for an 8-French internal/external nephroureteral stent.
2. Although an internal/external stent could not be placed on the right side, a 5-French pigtail catheter was left across the right-sided anastomosis to the ileal conduit. In addition, an 8-French nephrostomy tube was left in the right renal pelvis.
3. A tight residual stenosis is noted at the right ureteral implantation anastomosis.
4. No definite stones were seen on this examination.
PLAN: The above findings were discussed with the referring team for operative planning
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