Patient was brought to the operating suite, placed in the lithotomy position, prepped and draped in the usual sterile fashion. After adequate general anesthesia was obtained, Ancef was given preoperatively. The cystoscope was inserted per urethra after a time-out was performed. The urethra was normal. Prostatic lobes were seen and enlarged. There was a median lobe kind of pointing over a little bit to his right side. Bilateral ureteral orifices were normal. Bladder was normal, but there was a cystic lesion that was anterior, but if you followed it, it actually seemed to attach more laterally on the left prostatic lobe bladder neck area extending into the bladder. Went ahead and did some biopsies of it with just a cold cup and sent it off separately to Pathology and then used the loop to resect the area on the prostate without any difficulty. Ellik was used to remove the chips. Hemostasis was excellent. The chips were sent separately as a specimen too of that prostatic mass area on the left lobe. At the end of the procedure, there were no specimens. The bladder was clear. Went ahead and left some fluid in and removed the cystoscope. A Foley catheter was placed without any difficulty and was put to drainage.
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Cystoscopy with forceps manipulation of ureteral stent
Procedure : Cystoscopy, forceps manipulation of left ureteral stent, replacement of indwelling Foley catheter
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Details of Procedure: The patient was taken to the OR. Time-out completed. Sterilely prepped and draped in dorsal lithotomy position, and administered monitored anesthesia 30 degree cystoscope lens was passed with 22 French sheath into the bladder. Normal anterior urethra. Benign prostatic hyperplasia with obstruction and high bladder neck. The stent was visualized emanating from left ureteral orifice, and this was visualized fluoroscopically at the proximal end of the stent as well. With direct and fluoroscopic visualization, the stent was grasped initially with 30 and subsequently 70 degree lens and grasping forceps, and the stent was manipulated out distally to bring the curl of the stent back in the expected position of the left renal collecting system. Position appeared much improved. There was significant redundancy in the bladder once I then pushed the stent back using sheath of the cystoscope into the bladder, but we were very pleased with the overall position. The scope was withdrawn.
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Fourteen French Foley catheter well lubricated was passed with sterile technique in the bladder, with return of clear irrigating fluid. 10 milliliter sterile water used to inflate balloon.
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2018 Payment Policy for Blue Light Cystoscopy
In the 2018 Outpatient Prospective Payment System (OPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) finalized their proposal, without modification, to allow for a complexity adjustment when blue light cystoscopy is reported on the same claim as certain cystourethroscopy CPT codes. Rationale Traditionally, CMS explains in the final rule, white light (or standard) cystoscopy, […]
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Cystoscopy Urethreal Dilation
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Post-op Diagnosis: Same
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Procedure : Procedure(s):
CYSTOSCOPY DILATATION URETHRAL
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Indications: Patient with history of bulbar urethral stricture. Dilated in the past. Now with suspected recurrent condition.
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Details of Procedure: Informed consent. IV antibiotics. Operating room. Appropriate anesthesia. Dorsolithotomy position. Prepped appears fashion. Rigid cystoscope 17 French obturated per urethra bladder. Bulbar urethral stricture noted. Glidewire placed. Dilated using Goodwin sounds up to 24 French. Not too dense stricture. Not much resistance. I then took a cystoscope back in the bladder direct vision. Full endoscopy revealed no evidence any tumors, stones, diverticuli. I then used a 20 French silicone catheter hole punch over the Glidewire into the bladder dependent drainage. B and O suppository placed.
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Anesthesia Type: General anesthesia
This was coded 52281
Any thoughts??
Thank you
Vaginoscopy with Cystoscopy
They also do pediatric vaginoscopies for the same reason sometimes. Would it be billed as 57420 also?
Any help and guidance would be greatly appreciated!