Ask Dr. Z

I am leaning towards code 50395 for this example, but I have read conflicting opinions that code 74485 should/should not be reported. Could you provide your guidance and opinion? "Indications: Pre-op access for lithotripsy; nephrolithiasis. After injection of 1% subcutaneous lidocaine, an 18 gauge x 15 cm Hawkins needle was used to access a right posterior, inferior calyx under fluoroscopic guidance (after inflation of a proximal ureteral balloon and injection of approximately 5 cc contrast). The stylet was removed, and reflux of urine was confirmed. A 0.035" stiff Glidewire, with the aid of a 5 French Berenstein catheter, was placed in the urinary bladder to maintain access. The Berenstein catheter was then exchanged for an 8.5 French nephroureteral stent. A small amount of contrast was injected to confirm placement. The wire and stylette were then removed. Final sonographic image was obtained to confirm placement. The catheter was sutured into place using a 2-0 silk suture,and it was then capped. Sterile dressings were applied."