Proper coding for Left ureteral calculus manipulation?

jozog@cayugamed.org

What is the correct procedure code(s) for Right ureteral calculus manipulation and right stent insertion?
Operative note states "A guide wire was introduced into the right ureter. The patient had received intravenous contrast for CT scan and because of the obstruction, the contrast was seen filling the intra-renal collecting system, but there was no contrast in the ureter secondary to the obstruction in the proximal ureter. A guide wire was introduced and the open-ended catheter advanced. The calculus was in the proximal ureter and was manipulated proximally and once this was done, a 7-French stent was easily placed under fluoroscopic monitoring with good proximal and distal positioning obtained." Our coders captured BT1FZZZ Dilation of Left ureter with intraluminal Device, via Natural or artificial Opening Endoscopic, BT1FZZZ to capture the fluoroscopy, and 0TJ58ZZ to capture the inspection of the kidney, Via endoscopy.

This in my opinion does not capture the additional procedure of manipulating the stone which is not routinely done during stent insertion. I was at a loss for the appropriate root operation to use, but the closest I could come up with was 0TN68ZZ "release right ureter, via natural or artificial opening endoscopic." Our Coders disagree with the need to capture the manipulation. Is manipulation of the stone inherent in the Stent insertion?

Amy_Stremming_1992

Based on this coding clinic, I would agree with the coders and code the dilation (see 2nd example):
ICD-9-CM Coding Clinic, March - April 1985 Page: 13 to 14   

Question:

What is the proper code for an unsuccessful ureteral stone extraction using a stone basket?

Answer:

Other than the code for failed forceps, ICD-9-CM Procedure Classification does not have specific codes to designate procedures that could not be successfully completed. The general coding rule is to code the extent of the procedure carried out.

Examples:

• Cystotomy with use of stone basket for extraction of ureteral calculus but the calculus could not be reached or could not be removed. Code procedure as cystotomy, 57.19.
  
• Transurethral approach for removal of ureteral stone with unsuccessful attempt to pass endoscope to site of stone in ureter and, therefore, no manipulation of stone. Code as ureteral endoscopy if the endoscope was passed into the ureter, 56.31; otherwise, code as a cystoscopy.
  
• Ureterotomy with passage of endoscope for attempted removal of calculus which failed to remove calculus. Code the ureterotomy, 56.2.
  
• Passage of endoscope through previously established ureterostomy for removal of calculus with failure to remove calculus. Code as 56.31 if the approach was through a cutaneous ureterostomy.

Another example of coding to the extent of procedure performed is an intended cholecystectomy with exploration of the common duct. However, upon entering the abdominal cavity, the finding of metastatic malignancy involving stomach and duodenum with possible primary site in pancreas necessitated canceling the intended procedure and closing the operative wound. The procedure is coded as an exploratory laparotomy, 54.11, since it was the extent of the procedure performed.

jozog@cayugamed.org

Wouldn't it make a difference since the manipulation was successful?

Amy_Stremming_1992

I would classify the manipulation as part of the dilation in this case since the stone was not extracted/extirpated/destroyed; the movement of the stone dilated the ureter which was the intent of the procedure.
To me, this is along the same lines of inserting a cardiac stent and pushing a plaque to the sidewalls of the artery with the stent insertion; nothing is done to destroy/extract the plaque, it is just manipulated (if you will) in order to dilate the artery for improved blood flow.