Marisela Posted Wed 08th of May, 2019 12:18:14 PM
The office is in a bit of a conundrum as to which are the appropriate codes for this following out of the ordinary case. The physician submitted codes 50693, 50961 and 53899; however, we feel as there are more appropriate codes but we are unable to pinpoint the appropriate one(s) and do not want him to miss on any potential reimbursement.
The patient is a 76-year-old female with a renal transplant with infected stone, multidrug resistant. She had an episode of a TIA when she was planned for a ESWL. Given the issues with her stone in the transplant, she was elected for ureteroscopy and laser lithotripsy. The patient had a percutaneous nephroureteral tube in place for drainage of the transplant kidney and the infected urine. The stone was infected and the patient was evaluated by infectious disease. The patient was pre-admitted the day prior for IV antibiotics and is here today for definitive treatment of the stone.
NARRATIVE. The patient was brought to the operating room & underwent anesthesia. She was left in a supine position. She then had a Foley catheter placed per urethra. We then removed her nephrostomy bag & capped it. We then placed 10/10 drapes around the percutaneous access site & then prepped and draped her in usual manner for a percutaneous stone procedure. At this time, we then used a PCNL drape and covered draped her and we then began the procedure with advancing a Super Stiff wire through the nephroureteral stent. We were able to pass a Super Stiff wire all the way down to the level of the bladder, confirmed by fluoroscopy. We then advanced a dual lumen ureteral access sheath and we were able to pass the access sheath all the way down to the level of the bladder. Before passing a second wire down, we then performed pyelogram by withdrawing the dual lumen and filling the renal collecting system and visualizing the ureter as well down to the level of the bladder.
Once we had visualization of the anatomy, we advanced the dual lumen down to the level of the bladder. We then advanced a sensor wire through the dual lumen. We then push pulled the dual lumen leaving both wire in place. We then advanced a 9.5-French ureteral access sheath over the Super Stiff wire. We did need to make a small 0.5-cm incision extending the skin incision to create a little bit less tightness around the access sheath. We were then able to advance the access sheath all the way into the level of the renal pelvis, at which point we then removed the introducer and then advanced a 6-French ureteroscope. At which point, we were able to immediately visualize the stone. We then passed the 200 micron laser fiber into the renal pelvis and then fragmented the stone into multiple pieces.
At this time, we then used a zero tip nitinol basket and removed all the stone fragments and then repeated a pyelogram through the ureteroscope. We then were able to systemically scope the renal pelvis and the renal collecting system, noting no further sizable stones, only some stone debris remaining. At this time, we then brought to scope to the UPJ and then advanced a second sensor wire down to the level of the bladder. We then advanced the scope all the way down to the level of the bladder and then scoped the entire ureter noting no obstructive stones. At this time, we then backed the access sheath out leaving the ureteroscope in place. We then advanced a 6-French variable length transplant stent over the safety wire and advanced the stent all the way to the level of the bladder, at which point we then deployed the distal curls and we were able to visualize 3 curls in the bladder and proximally we brought the pusher to the level of the kidney. Unfortunately the pusher was very tight and against the ureteroscope, we then backed the ureteroscope out leaving just the pusher and the stent and the wire in place. At this point, we then advances the pusher to the level of the mid pole calix. At which point, we then deployed the stent by pulling out the wire. Unfortunately, it does not appear that the stent achieved good curls in the transplant kidney and it appears that the tip of the stent most likely is inside one of the calices, however, given the inability to bring any scope back into place and that the patient has been sent to the long term, we decided to conclude the case with the stent positioned as is.
At this point, we concluded our procedure. We the removed the Foley catheter. The patient was then extubated and returned to the recovery room without any complication.
SuperCoder Answered Thu 09th of May, 2019 03:37:47 AM
Marisela Posted Thu 09th of May, 2019 08:44:42 AM
I'm sorry, did something change?? I've done this once or twice in the past 6 yrs with AAE and have gotten a response. We're just trying to determine if the codes listed are appropriate or not....
Marisela Posted Thu 09th of May, 2019 09:02:40 AM
"The office is in a bit of a conundrum as to which are the appropriate codes for this following out of the ordinary case. The physician submitted codes 50693, 50961 and 53899; however, we feel as there are more appropriate codes but we are unable to pinpoint the appropriate one(s) and do not want him to miss on any potential reimbursement." What would YOUR opinion be based on the op report of the appropriate coding? We do not want to get denied or flagged should the insurance carrier request the op rpt for audit as they have tendencies to do with us.
SuperCoder Answered Fri 10th of May, 2019 07:07:52 AM
Hope you are doing good.
This is our defined process; this platform is for Ask An Expert (AAE) queries and it does not provide coding of op-reports. Since, you have provided the complete report, we have to take up this through SuperCoder on Demand (SOD) (http://www.supercoder.com/coding-answers/coding-on-demand). For coding of an operative report or chart note and you can contact (866)228-9252 or e-mail firstname.lastname@example.org for more information.
It is requested to send the report through defined channel i.e. SuperCoder on Demand (SOD). The coding of the report might charge you more. Once you send the report to the customer service email, kindly mention that you have already placed the op-report in the AAE. So, that we can adjust your this AAE query charges.
Looking forward to serving you well.
Marisela Posted Fri 10th of May, 2019 08:44:09 AM
This is highly unacceptable as I have perused several other specialities and have seen you answer and review other op reports and rather recent. I spoke with upper mgmt there yesterday and was instructed to do as the above because this is NOT something we WANT or REQUIRE you to code for us. I am providing the codes and am asking for YOUR opinion....I mean seriously why stay with you guys and pay for a service I rarely use and get this back....I will report this back to the uppers again today!
SuperCoder Answered Mon 13th of May, 2019 04:40:15 AM
Hope you are keeping good.
This is under discussion.
We will get back to you soon.
SuperCoder Answered Tue 14th of May, 2019 05:46:43 AM
Hope you are doing good.
We hope that discussion with our representative clears the process about the AAE and SOD services.
If you have any AAE query, please post it in this tread only.
Else, if you are sending the op-report through SOD, then we can adjust the charges of this query.
Looking forward to serving you well.