Procedure: cystoscopy, suprapubic cystostomy
DX: Chronic urinary retention, catheter dependence.

DESCRIPTION OF OPERATIVE PROCEDURE: With the patient suitably anes-
thetized in dorsal lithotomy position, his Foley catheter was removed,
then the genital hairs were clipped with the electric clippers, and
he was prepped and draped in the usual sterile fashion. The 20 French
cystoscope sheath was inserted under direct vision, and bladder
carefully inspected. The bladder was half-filled to capacity, and the
cystoscope was then withdrawn. An 18 French van Buren sound was passed
easily per urethra, and its tip palpated in the suprapubic region. A 1
cm transverse incision was made in the suprapubic area overlying the tip
of the sound, and then the sound was exposed with the cautery. The cut
end of an 18 French Foley catheter was then firmly affixed to the tip of
the sound (the catheter had been pre-checked that the balloon was not
ruptured). The catheter was then copiously lubricated with K-Y jelly,
and passed in antegrade fashion through the bladder and urethra by
pulling back on the sound until the sound completely exited the meatus.
At this point, the sound and catheter were disassembled, and the
catheter was then followed back into the bladder with the cystoscope as
an associate gradually pulled back on it. At this point, the tip of the
catheter lay within the bladder, and the catheter balloon was then inflated
under direct vision with 10 ml sterile water. The balloon was gently
snugged to the bladder dome, and the cystoscope was withdrawn. The
suprapubic wound was closed with four sutures of 3-0 Prolene placed in either
simple or horizontal mattress-fashion, and the catheter was tied to three
of these sutures.

The patient was cystoscoped once more to get a final look at the
suprapubic catheter in position, and it appeared to be located at the
bladder dome, without impingement upon the bladder neck. The cystoscope
was then withdrawn, and the catheter irrigated clear without difficulty.
It was connected to gravity drainage. Antibiotic ointment and a gauze
dressing were applied to the suprapubic site.

The patient tolerated the procedure well without complication, and
bleeding was minimal. He was awakened without difficulty at the conclusion
of the procedure, extubated, and transferred to the recovery room in stable
condition, without complication.

I feel this is more than a bladder aspiration 51102 but I am unsure if it meets requirements for an open 51040. There was an incision made in the abdomen then cauterize until the sound was exposed which may be enough to classify as an open cystostomy. I would like some opinions on how this should be coded.

Thanks,
Amy