AHA Coding Clinic® for HCPCS - 2026 Quarter 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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Article Overview
This premium coding article focuses on a kidney-stone procedure case in urology and reviews the operative workflow, including cystoscopic access, retrograde imaging, ureteroscopic evaluation, laser fragmentation, and use of steerable suction-assisted catheter and access-sheath technology. It is relevant to coders and billing staff working with endourology documentation, device-based procedural details, and related reporting considerations.
Why This Topic Matters
Procedures for complex urinary stone treatment often involve multiple instruments and imaging steps that affect accurate procedural understanding and coding review. This article helps readers recognize the device- and technique-heavy elements documented in the encounter.
Article Sections
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Procedure overview and stone history
Introduces the recent stone-treatment history and the current residual stone burden prompting the encounter.
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Cystoscopy, access, and retrograde imaging
Covers bladder access, stent removal, ureteral cannulation, contrast instillation, and upper-tract imaging findings.
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Steerable access sheath and ureteroscopic treatment
Describes placement of a steerable suction ureteral access sheath, flexible ureteroscopic evaluation, laser fragmentation, and fragment removal.
What You Will Learn
- How a complex renal stone procedure is documented at a high level
- Which operative steps involve endoscopic access and fluoroscopic imaging
- How steerable suction-assisted device usage is reflected in procedural documentation
- What broad information coders look for in endourology operative notes
Who Should Read This
- Medical coders
- Billing specialists
- Urology coding staff
- Clinical documentation reviewers
- Revenue cycle professionals
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