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Nephrostomy tube replaced with a ureteral stent via an ileal conduit

Julie Posted Sun 19th of May, 2013 02:06:15 AM

Good morning.

This is my scenario: The patient was admitted to exchange his nephrostomy tube for a ureteral stent. The ureteral stent was inserted via an ileal conduit.

1. What would the first-listed diagnosis be in this case?
2. What would the CPT codes/ICD-9 procedure codes be in this case?

Thank you.

SuperCoder Answered Wed 22nd of May, 2013 09:18:00 AM

Hi,

This is with my editor. She will get back with the answer soon.

Thanks

SuperCoder Answered Wed 22nd of May, 2013 17:14:18 PM

Hi there.

Without more details it is difficult to determine the proper coding for your scenario.

For the diagnosis, you should use whatever the reason for the stent placement is. Perhaps it is hydronephrosis (591) or ureteral stricture (593.3).

For the procedure coding, the answer depends on the procedure details and the approach. There is no code for the removal of the nephrostomy tube. If the provider went from above and placed the stent, then 50393 would be appropriate. If the stent was an external stent, 50688 would be appropriate. If the provider performed and ileoscopy and placed the stent from below, 44383 would likely be the best coding.

I hope this helps.

Best,
Leesa

Leesa A. Israel, BA, CPC, CUC, CMBS
Executive Editor, The Coding Institute

Julie Posted Wed 22nd of May, 2013 18:17:28 PM

You would not use a V code for the exchange? That was the reason he came in- the exchange.

SuperCoder Answered Thu 23rd of May, 2013 17:38:30 PM

You could use V55.6 as the dx -- that code can be the primary diagnosis, but I would consider that more of an informational diagnosis. There is a clinical, diagnostic reason the patient has the stent, and personally I would say that should be the primary dx with V55.6 as secondary. While you shouldn't code just to get paid, you should also note that many payers won't reimburse you with V55.6 as primary. If you are able to give a better diagnostic picture to the payer as to why the patient needs the stent, I would suggest using a code such as 591 or 593.3 (whatever the patient's condition is) as primary.

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