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PCNL with additional work (more than 50081?)
Looking for some advice on the following (the relevant details are in bold):
POSTOPERATIVE DIAGNOSIS: Left kidney stones.
OPERATION: Left percutaneous nephrolithotomy.
The patient has upper pole kidney stones,
one of them more medially, approximately 14 mm to 15 mm
greatest length on CAT scan, another one smaller 8 to 9 mm at
another part of the upper pole. On his arrival to the preop area,
the patient was sent to Interventional Radiology and the Dr.____
placed a nephroureteral access catheter with two wires going into
the bladder. In his opinion, the patient has the large stone burden
within a diverticulum with acute angle towards the pelvis which was
demonstrated on nephrostogram although he was able to easily pass
the wires.
The patient was identified in the waiting room and brought into the
OR on the stretcher. General anesthesia was administered. A Foley
catheter was placed. The patient was then flipped onto the OR table
into the prone position. Two rolls were placed under him. Axillary
rolls and shoulder pads were secured as well. All pressure points
including elbows and feet were secured. The patient’s left flank
was then prepped and draped in the sterile surgical fashion.
Time-out was performed. Consent and laterality were verified. The
patient received 2 g of Ancef before Interventional Radiology and
another 160 g of gentamicin before the PCNL.
Fluoroscopy was brought in. Both stones were identified on fluoro.
Due to the very medial location of the nephroureteral stent and the
medial stone, the nephroureteral access catheter was going in at a
complete vertical direction very medial close to the spine. The
C-arm thought to be rotated 45 degrees. At this point, I prepped
the nephroureteral access catheter with some additional Betadine and
removed the two wires that he had placed, a new Amplatz Super Stiff
wire and a regular Sensor wire. I then slowly removed the
nephroureteral access catheter to the level of the renal pelvis and
injected some contrast to opacify the collecting system confirming
the larger stone burden location more medially where the ureteral
access sheath was going through. Another stone still in the upper
pole but at a much lateral position on the kidney was identified
with an acute angle between the two stones. Next, the
nephroureteral access catheter was removed. The point of wire entry
into the skin was extended with a #11 blade approximately 12 mm.
Next, a NephroMax made by Bard balloon was inserted over the Amplatz
wire. The 30-French sheath was placed over the wire as well. I
then advanced the balloon tip to the level of the upper pole calyx
where the stone was and inflated the balloon to 18 cm of water. I
then attached the 30-French sheath over the balloon into the calyx
and removed the deflated balloon and removed it. Next, I introduced
a 26-French nephroscope using continuous irrigation was inserted
through the tract into the upper pole. Careful inspection revealed
that the patient had multiple conglomerate of stones rather than one
large stone measuring in size from 3 to about 6 to 7 mm. Due to the
acute angle of the infundibulum, I had a hard time rotating the
nephroscope to access all the stones, but I was able to insert the
ultrasonic Lithotripter, and using ultrasound and some LithoClast
activity I removed some of the stone burden. The patient still had
multiple stones deeper in the calyx and therefore removed the rigid
nephroscope and inserted a flexible cystoscope into the calyx, and
using a Nitinol basket I was able to retrieve the remaining stones.
At least six or seven of them were manually removed and sent for
specimen. Reinspection revealed no residual stones in the medial
calyx. I could not access the other upper pole calyx with the
remaining stone due to the acute angle between the two calices. The
renal pelvis was inspected. It was intact. I did not see any
stones in the renal pelvis or UPJ. Next, the collecting system was
opacified, and over the Amplatz wire I passed a 6 x 28 stent through
the nephroscope and noted coiled in the bladder and in the renal
pelvis. Next, the nephrostomy sheath was removed and after _____ I
passed a 22-French Council tip Foley catheter over the Sensor wire.
The tip of the catheter was noted to be in the upper pole calyx
although I did migrate somewhat distally after the balloon was
inflated with 1.5 mL of sterile water, but I was able to easily
irrigate the system. Some extravasation was noted, mostly from the
tract coming out adjacent to the 20-French Council tip. No
significant bleeding was noted. The Council tip nephrostomy tube
was secured to the skin with a 3-0 nylon stitch. A 4 x 4 dressing
and Tegaderm were then used to secure it in place. I then flipped
the patient into the supine position. The patient tolerated the
procedure well, was extubated, and sent to the recovery room in
stable condition.
Initially, I was going to bill just 50081 for the PCNL and 50684 for contrast. However, the level of detail & reading I’ve done suggests I can add on 52352 for the work involving the cystoscopic (vs the nephroscope) basket removal of calculi and 50395 (or 50432?) as I think the #11 blade incision extension counts as a new access? Perhaps I’m overanalyzing this one. Any help would be appreciated. Thanks.
Can a practice have more than one billing company?
Can a practice have one company to bill there office visits and one company who bills there diagnostic testing that is done in their office?
Emergency room visits (more than 1 visit within 24 hours)
Hello fellow Coders,
If a Patient makes more than one visit per day to the Emergency Dept. (e.g. 2, 3, 4 ED encounters within 24 hours); in what instances would more than one encounter be paid? Are there any guidelines available in reference to such?
Thank you in advance.
Florida AG Arrests Dentist and Office Manager for More Than $50,000 in Medicaid Fraud
Attorney General Pam Bondi and the Pembroke Pines Police Department arrested a dentist and their office manager for defrauding the Medicaid program out of more than $ 50,000.
The post Florida AG Arrests Dentist and Office Manager for More Than $ 50,000 in Medicaid Fraud appeared first on The Coding Network.
Medical Malpractice Reform is Even Harder Than it Sounds
The notion of medical malpractice reform is fraught with difficulty. At the heart of it is the reaction to individuals and their families to injury or death resulting from human error on the part of the medical system. As a people, the two things we have zero tolerance for are errors in our financial processes and our medical processes. The difference is that when it comes to finance, remuneration is easily accepted at the face value of the error leaving it to the judicial system to figure out any punishment that is necessary. With medical malpractice, however, there is the concept of trying to make whole the injured party, which is subjective with an unknowable future cost, plus the inherent empathy we all feel as human beings for medical damage.
The Public Handicapping
As an example, if a person loses their sight after undergoing a procedure that was undertaken to make the individual well but it goes poorly due to a mistake the physician makes, even though we know the individual can live out their life, there is such an abhorrence to the very concept that a jury of peers is predisposed to not only making the victim whole, but in some way seriously punishing the “perpetrator;” partly for the victim and partly for ourselves. Thus medical malpractice reform is handicapped by a public and congress attempting to preserve the ability to punish the perpetrators of such an unfathomable act.
Universal Health Care
The truth is that we need universal health care to solve this dilemma. If someone is blinded by poor medical treatment, as abhorrent the thought is, their medical treatment would be guaranteed for life, and the calculation of the other costs for their life becomes more finite. Transportation, accommodations such as animal assistance, home cleaning, shopping, and all the things one needs to survive comfortably become calculable–without rampant emotion. It comes down to how we balance the costs of such egregious injury from medical malpractice with the need to keep the costs of medicine under control. Preventable injuries, as deplorable as they are, should not be a windfall profit to the victim, yet the responsibility for the damage must be atoned for by the perpetrator in accordance with our laws against violence against others. As with all forms of justice, the goal is to “make whole” the victim as much as can be accomplished, while holding true to the concept of justice.
To learn much more about finding a good dental malpractice lawyer, visit malpractice-history.com where you’ll find this and much more, including malpractice statistics and advice.
Medicare Payments Higher at HOPDs than ASCs, Doc Offices
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Misc J code with description that is longer than 80 characters
I anticipate billing a new drug using j3490. I know I need to put the description information, Name, generic name, route of administration, dose in Box 19. All of this info will be more than 80 characters. Is there somewhere else I can put the information, or should I abbreviate certian things?
HPI elements as noted by the physician (rather than as stated by the patient)
I know this is an old question, but I am drawing a blank: Does the HPI have to be strictly what the patient tells the physician, or can it…
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