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excision of ureteral stricture

David Posted Wed 17th of December, 2014 17:00:47 PM

Please help me with coding this surgery:

excision of ureteral stricture
ureteral reconstruction with a appendiceal interposition graft
omental wrap

SuperCoder Answered Fri 19th of December, 2014 03:23:42 AM

Thanks for your query.

Can you please share a brief description of procedure.

Thanks !!

David Posted Tue 23rd of December, 2014 11:58:10 AM

We made a midline skin incision at the site of his previous midline skin incision. I biopsied the fibrotic mass in the right ureter and sent it to pathology for frozen section. I then excised the indurated and hard portion of the ureter where the stricture was located. We then considered trying to do a reanastomosis but the 2 ends were not close enough together. Therefore we elected to do an interposition graft. After reviewing the options, the patient's appendix appeared ideal for this procedure. We did an appendectomy, we cut both ends off and we irrigated to wash out the appendix. We then spatulated both ends of the ureter and spatulated both ends of the appendix, and then sutured the ureter to the appendix. We had a very nice ureteral-appendical anastomosis. We then placed a double J stent with one coil in the bladder and the other in the renal pelvis. We then decided to do an omental flap to wrap this ureteral segment so that it prevented it from falling back into the retroperitoneum and being entrapped.

SuperCoder Answered Fri 26th of December, 2014 09:04:16 AM

There is no listed code for the above procedure, you will have to use unlisted code for above procedure, 53899, Unlisted procedure, urinary system.

Thanks !!

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