Ask Dr. Z

If a patient is having a ureteral stent placed via an ileal conduit, is it still reported with codes 50393/74480 since the code states the catheter is inserted through the renal pelvis?  Or would it be unlisted since it is via the ileal condiut?

Report: Conversion of a left nephrostomy tube to a left nephroureteral stent through the patient's existing urostomy. Clinical Information: This patient is an 80-year-old gentleman has a history of left renal obstruction. He is pulled out his tube from the urostomy in and now presents for conversion of his existing left nephrostomy tube to nephroureteral stent. Procedure: After the procedure was explained and consent obtained from the wife, the patient was placed in a decubitus position on the fluoroscopy table. The patient had the urostomy site and nephrostomy tube exit site prepped and draped in the sterile fashion. The patient was numbed with 1% lidocaine solution around the nephrostomy tube exit site. The nephrostomy tube was removed over a 0.035 guidewire and a 5 French vertebral catheter was then placed within the renal collecting system. This in conjunction with a 0.035 hydrophilic guidewire was utilized to access the left ureter. This is also used to pass the anastomosis and enter the ileal conduit. After this was then, the catheter and guidewire combination were used with fluoroscopic guidance to traverse the conduit with the catheter and wire protruding through the ostomy site. Exchange was made for a 0.035 Amplatz guidewire. After this was done, the catheter was removed. The patient was then placed in the supine position on the fluoroscopy table. A 10 French drainage catheter was then placed over the guidewire using fluoroscopic guidance into the proximal loop is located within the renal pelvis. The guidewire was then removed. A contrast injection with gadolinium demonstrates the tip of the catheter to be located within the renal pelvis. The patient tolerated the procedure. The patient received Versed and fentanyl intravenously for conscious sedation. Impression: Conversion of the left nephrostomy tube to a left nephroureteral stent which extends in a retrograde fashion through the urostomy site.