Cpt code for Percutaneous retrograde & antegrade Nephrostogram

Percutaneous retrograde & antegrade Nephrostogram
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Physician Responsibility
In this procedure, the surgeon injects contrast material through an indwelling ureteral catheter or an existing nephrostomy or pyelostomy tube to analyze the internal structures of the kidney, renal pelvis, and/or ureter. This procedure is mainly performed to evaluate any defective or abnormal function of the nephrostomy or pyelostomy tube or to recognize any symptoms that could signify any pain, blockage in the ureteropelvic junction, or any urine leakage around the nephrostomy tube insertion site. At first, the skin around the nephrostomy tube insertion site is washed out with an antibacterial solution. The radiologist then injects contrast material filled in a syringe to the pyelostomy or nephrostomy tube. The radiologist injects contrast material slowly through the tube into the ureter and kidney. Once the ureter and the kidney fill with the contrast material, the radiologist performs x-ray photography of the kidney, renal pelvis, and/or ureter. These tips are really important for Certification exams like CPC, you can go through sample CPC questions here which is surely help in clearing CPC exam.

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Pyelography: X-ray images of the renal pelvis of the kidney with associated structures after administration of a contrast agent through ureterostomy or nephrostomy catheter tube.

Nephrostomy tube: A very small, soft, plastic tube, which is placed into the renal collecting system for temporary drainage of urine, abscess, or calculus removal.

Pyelostomy tube: A plastic tube which is placed in the renal pelvis of the kidney for drainage of urine. It is placed either percutaneously or during an open surgical procedure.

Nephrostogram: An x-ray imaging of the kidney after injection of a contrast agent through a nephrostomy tube.

Pyeloureterogram: An x-ray imaging of the kidneys, renal pelvises, and ureters after injection of a contrast agent through a nephrostomy or ureterostomy tube.

Question: A patient presented with previously placed nephrostomy tube and a 3-cm renal pelvic stone within the same kidney. The urologist preformed an antegrade pyelogram and after removing the nephrostomy tube used a Bard X-Force balloon to dilate the nephrostomy tract under fluoroscopy. Then the physician prepared the nephroscope, removed the balloon and used the nephroscope. Using the Cyperwand lithotripter, he fragmented the stone using ultrasound and sucked out the fragments. Fluoroscopy revealed a small stone burden left, so the urologist used a cystoscope, a rigid nephroscope and grasping forceps to remove the fragments. He used a 22-french foley as a follow-up nephrostomy tube for postoperative drainage, and performed a second antegrade pyelogram to confirm tube position. He did not place a stent. Are 50394 and 50561 the only codes to use?

CPC Practice Exam - Medical Coding Study Guide Please Click Here!

Answer: No. You should report four codes for this procedure. First, for the fragmentation of the renal calculus and fragment removal, report 50081

(Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; over 2 cm).

Their are new CPT codes from 2016 for coding Nephrostogram. Check the list of new CPT codes here.

Next, submit 50394 (deleted in 2016) (Injection procedure for pyelography [as nephrostogram, pyelostogram, antegrade pyeloureterograms] through nephrostomy or pyelostomy tube, or indwelling ureteral catheter) for the nephrostogram

and antegrade pyelogram. Then, report 50398 (Change of nephrostomy or pyelostomy tube) for the changes of the nephrostomy tube. Capture the urologist's reading of the nephrostogram and antegrade pyelogram using 74425 (Urography, antegrade [pyelostogram, nephrostogram, loopogram], radiological supervision and interpretation). Append modifier 26 (Professional component) to indicate that your physician only read and interpreted the study.


INDICATION: Colon cancer, pelvic fistula, nephrostomy tubes in place.

Dilatation of the right renal collecting system on CT scan earlier

TECHNIQUE: The procedure, risks, indications, alternatives were all
explained to the patient. Informed consent was obtained. The back
was prepped and draped in usual sterile fashion. Contrast was
injected into the existing nephrostomy tube. The right-sided
nephrostomy tube was patent. A Glidewire was advanced out the
proximal sidehole the tube was removed. A new 10 French nephrostomy
tube was then placed with the pigtail is formed in the renal pelvis.

Contrast was injected to confirm position..

FINDINGS: The right-sided nephrostomy tube pigtail is in good
position and coiled in the renal pelvis. No extravasation is seen.

No hydronephrosis.

Excellent tube position after catheter replacement..

1. Successful right-sided nephrostomy tube change.
CPT: 50398, 75894-26

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