hcpcs coding

Appendix B Additional Practice Exercise urgical Case #68 ure: Procedure: nosis: Diagnosis: Indications: Technique: Operative Report Distal left ureteral stone Distal left ureteral stone This patient was found to have a large stone in the distal left ureter imme- diately above the ureterovesical junction. He was brought to the operating room for ureteroscopy and laser lithotripsy. Following induction of general anesthesia, the patient was placed in lithotomy position and prepped and draped in the usual manner. Cystoscopy was performed and revealed a high lateral ureteral orifice because of a moderate- sized to medium love of the prostate. A 0.38 guidewire was passed through the cystoscope into the ureter up to the level of the stones which was only approximately 2 cm. A 4-mm balloon was loaded on the wire and passed through the orifice and only into the intramural ureter. The balloon was inflated with 14 atmospheres of contrast, deflated, and removed. Both short/ semi-rigid ureteroscope was then passed under direct vision into the left ureter and the stone was encountered immediately above the ureterovesical junction. A 365 micro laser fiber was used to fragment the stone with a frequency of 10 Hz and power that ranged from 10 to 15 watts. The stone was fragmented into multiple small pieces. The laser fiber was removed and an escape basket was then passed through the ureteroscope and stone fragments were basketed and pulled into the bladder and dropped. At the termination of the procedure, most of the stone fragments had been basketed and removed from the ureter. The ureteroscope was withdrawn. The cystoscope was passed into the bladder. The bladder was drained. A few very small stone fragments were recovered and sent to the laboratory for examination. Codels)