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Bladder Repair with Ureteroneocystotomy

Leah Posted Fri 03rd of October, 2014 10:06:14 AM

Hello,
Any help on the scenario below would be greatly appreciated:
Pt was in for a colostomy reversal. Her surgeon fired the stapler through the bladder and vagina, creating holes in both. At this point, our surgeon and a GYN specialist was called in. The GYN specialist ended up having to do a TAH/BSO to increase mobilization of the vaginal wall and aid in exposure.

OUR surgeon did the cystorrhaphy. He then intubated the ureteral orifices and in doing so, found a duplication of the right ureter. Eventually, he anastamosed the two duplicated right ureters together in a Wallace-type fashion, then performed the right ureteral reimplant of the combined ureters to the bladder. For the left ureter, he was able to just place a stent--no reimplant necessary.

Our surgeon then made a cystotomy and placed a suprapubic tube for drainage.

I see the 51860, and feel in this scenario, it should not have a -52 given the amount of added dissection and effort he had to do to access and examine the bladder. I see 52332-LT for the left stent placement. I see 51040 for the SP tube. What I am not sure of is how to properly code the ureterostomy. Would it just be 50780 with a -22 since he joined the ureters together before the reimplant? Is there anything I am missing, or should not bill for that I have listed above?

Thank you,
Leah
CPC, CUC

SuperCoder Answered Mon 06th of October, 2014 06:55:17 AM

Thanks for your query.

There is a more appropriate code when duplicated ureter is anastomosed with bladder.You should use code 50782, Ureteroneocystostomy; anastomosis of duplicated ureter to bladder.

Also, Code 52332 is used when the provider places the stent using a cystourethroscope. For open stent placement in ureter you may use code 50605, Ureterotomy for insertion of indwelling stent, all types. Use the following code combination.

50782
50605-59 (Use modifier 59, distinct procedural service since as per CCI edit this code is included in code 50782)
51860-51
51040-51

Thanks !!

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