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Nephrolithotomy is a surgical procedure specifically designed for the removal of a renal calculus, commonly known as a kidney stone. The term "secondary surgical operation" indicates that this procedure is performed after an initial surgery, which may have been unsuccessful or required further intervention. During an open nephrolithotomy, a surgical incision is made in the skin over the kidney, allowing the surgeon to access the renal area directly. The procedure involves careful dissection of the soft tissues surrounding the kidney, including the incision of Gerota's fascia, which is a layer of connective tissue that encases the kidney. The surgeon meticulously identifies and controls blood vessels by placing loops around them to prevent excessive bleeding during the operation. Once the kidney is adequately exposed, a visual examination is conducted to locate the calculus. An incision is then made in the kidney at the site of the stone, allowing for its removal. The calculus is subsequently sent to a laboratory for analysis, which is a separate reportable service. After the stone is extracted, drains may be placed as necessary to facilitate fluid drainage. The procedure concludes with the closure of Gerota's fascia, removal of the vessel loops, and layered closure of the skin incision. It is important to note that CPT® Code 50060 should be used for the primary surgical procedure to remove the renal calculus, while CPT® Code 50065 is designated for this secondary surgical operation.
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The nephrolithotomy procedure is indicated for patients who have a renal calculus that requires surgical intervention. This may occur in cases where the calculus is too large to pass naturally, causing significant pain or obstruction. Additionally, it may be indicated when previous attempts to remove the calculus have failed or when complications arise from the presence of the stone, necessitating a secondary surgical operation.
The nephrolithotomy procedure involves several critical steps to ensure the successful removal of the renal calculus.
After the nephrolithotomy procedure, patients are typically monitored for any signs of complications, such as bleeding or infection. Post-operative care may include pain management and the use of drains to facilitate recovery. Patients are advised to follow specific instructions regarding activity levels and hydration to support healing. Follow-up appointments are essential to assess recovery and ensure that no further complications arise from the procedure.
| Short Descr | NL SEC SURG OPERJ CALCULUS | Medium Descr | NEPHROLITHOTOMY SECONDARY SURG OPERJ CALCULUS | Long Descr | Nephrolithotomy; secondary surgical operation for calculus | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 103 - Nephrotomy and nephrostomy |
| 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2023-01-01 | Note | Short and medium descriptions changed. |
| 2011-01-01 | Changed | Medium description changed. |
| Pre-1990 | Added | Code added. |