AHA Coding Clinic® for HCPCS - 2026 Issue 1; Ask the Editor

Steerable Catheter Devices

A patient had a recent left ureteroscopy with removal of a 7mm ureteral stone and left stent placement. A large volume stone remains in the left renal pelvis.A rigid cystoscopy was performed with a 22 Fr sheath and 30-degree lens that was inserted into the bladder. The ureteral stent was removed from the left ureteral orifice, which was cannulated with a hybrid wire, and advanced to the renal pelvis. Contrast was instilled in the collecting system and a retrograde pyelogram was performed under fluoroscopic guidance. The kidney demonstrated mild hydronephrosis with filling defects in the renal pelvis.A 12/14 Fr 46 cm steerable suction ureteral access sheath was inserted up to the renal pelvis. The flexible video ureteroscope was inserted and nephroscopy was performed noting a large renal pelvis stone, which was adherent to the urothelium. The stone was lithotripsed with a 200-micron laser. The stone was in multiple pieces and the fragments were removed with a steerable suction-assisted ureteral access sheath. No residual fragments were noted. A wire was left in the upper pole through the ureteroscope, the ureteral access sheath was removed, and the ureter was cleared. A ureteral stent (string off) was inserted under endoscopic and fluoroscopic guidance with good proximal coil in the upper pole calyx and distal coil in the bladder.We are unable to locate official guidance for facility reporting on which types of devices qualify as steerable catheters to report HCPCS code C9761. What is the appropriate code to report for a lithotripsy and stent removal during a cystourethroscopy/ureteroscopy when a steerable suction ureteral access sheath is utilized? Does a steerable ureteral access sheath meet the requirements for reporting HCPCS code C9761? ...

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