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What is Antegrade Pyelogram?

Antegrade Nephrostogram is also called Antegrade Pyelogram. It is a study of x-rays to diagnose the obstruction of the urinary tract. In Antegrade Pyelogram, the contrast dye is injected in the ureter, which carries the urine from the kidneys to the bladder. The flow of contrast is then studied with the x-rays images once it starts flowing from the kidneys into the ureters and urinary bladder. There are list of CPT code for antegrade Pyelogram (Nephrostogram) in surgery facility.

Need of Antegrade Pyelogram

Antegrade Pyelogram is used as an alternative when we don’t get any specific information after doing retrograde pyelogram or intravenous pyelogram. The antegrade pyelogram helps in the detecting the obstruction in the urinary tract. The obstruction can be due to stricture or narrowing of tract, kidney stone, tumor etc. So, whenever there is an obstruction, the contrast dye injected will be having problem to flow from kidneys to urinary bladder, which is getting detected in the x-ray images.

image courtesy: http://radiopaedia.org/

Antegrade pyelogram is also useful in evaluating kidneys and ureters before or after the surgery. If there is obstruction in urinary tract, a nephrostomy tube is place to divert the flow of kidney directly from the kidneys to the abdominal wall. Nephrostomy tubes are placed within the kidney to collect the urine directly from the kidney as it is generated.

Antegrade Pyelogram procedure

At first the patient will be injected with local anaesthetic agent. Now, with the help of an imaging guidance a needle will be inserted in the kidney, till it reaches to renal pelvis. After reaching renal pelvis, the contrast dye is injected. Now, a series of x-rays will be taken through the ureters for study of urinary tract. Now, a guidewire is inserted through the needle to allow the placement of nephrostomy tube or catheter. Once the guidewire is placed, the needle is removed and then the catheter is placed along the guidewire. Once the catheter is placed, guidewire is also removed. After the placement, a sterile dressing will be applied.

Description of CPT Codes for Nephrostogram

50430 – Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access

50431 ; existing access

50684- Injection procedure for ureterography or ureteropyelography through ureterostomy or indwelling ureteral catheter

50690 – Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service

50435- Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation

50387- Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation

50688 – Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit (use CPT code 75984 as S&I )

50382- Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation

50385 -Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation

50386 -Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation

50389 -Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent)

Old CPT codes used for Antegrade Pyelogram

For diagnostic antegrade pyelogram and Nephrostomy tube placement following cpt codes are used. Some of the CPT codes have been deleted in 2016 and New CPT codes have replaced them.

50390- for diagnostic antegrade pyelogram

50392- for placement for nephrostomy tube for drainage and/or injection percutaneous.

50394- for diagnostic antegrade pyelogram through the already placed catheter.

50393– for the placement of ureter catheter or stent into ureter through renal pelvis for drainage and/or injection percutaneous.

The supervision and interpretation (S&I) and imaging guidance codes used along with above cpt codes are 74425, 74470, 76942, 77002, 77012 or 77021. When the findings are given with procedure performed we have to code the S&I code. And when the guidance is used we have to code the guidance code. The guidance codes are included with the S&I code, hence when we are coding S&I code we are not supposed to code the guidance code with them.

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