CPT® Code 50070

1. Indications

The procedure of nephrolithotomy, specifically CPT® 50070, is indicated for patients presenting with renal calculi complicated by congenital kidney abnormalities. These conditions may include:

• Parenchymal Disease - A condition affecting the functional tissue of the kidney, which may complicate the removal of stones.
• Congenital Obstruction of the Ureteropelvic Junction - A blockage at the junction where the ureter meets the renal pelvis, potentially leading to hydronephrosis.
• Polycystic Kidneys - A genetic disorder characterized by the growth of numerous cysts in the kidneys, which can complicate stone removal.

2. Procedure

The nephrolithotomy procedure involves several critical steps to ensure the effective removal of the renal calculus:

• Step 1: Skin Incision - The procedure begins with a surgical incision made over the kidney to provide access to the renal area.
• Step 2: Dissection of Soft Tissues - Following the incision, the surgeon carefully dissects the soft tissues surrounding the kidney to expose the organ adequately.
• Step 3: Incision of Gerota's Fascia - The connective tissue known as Gerota's fascia is incised, allowing access to the perirenal fat that surrounds the kidney.
• Step 4: Control of Blood Vessels - Blood vessels in the area are identified and controlled by placing vessel loops around each vessel to minimize bleeding during the procedure.
• Step 5: Exposure and Examination of the Kidney - The kidney is then fully exposed and visually examined to locate the renal calculus.
• Step 6: Incision Over the Renal Calculus - An incision is made directly over the site of the renal calculus to facilitate its removal.
• Step 7: Removal of the Calculus - The calculus is located, extracted, and sent to the laboratory for analysis, which is reportable separately.
• Step 8: Placement of Drains - If necessary, drains are placed to manage any potential fluid accumulation post-surgery.
• Step 9: Closure of Gerota's Fascia - Gerota's fascia is closed to restore the integrity of the surrounding tissues.
• Step 10: Removal of Vessel Loops - The vessel loops used to control bleeding are removed once hemostasis is achieved.
• Step 11: Closure of the Incision - Finally, the skin incision is closed in layers to promote proper healing and minimize scarring.

3. Post-Procedure

After the nephrolithotomy procedure, patients may require monitoring for any complications related to the surgery. Expected recovery includes managing pain and monitoring for signs of infection or bleeding. The placement of drains, if utilized, will be assessed for output and may be removed once deemed appropriate by the healthcare provider. Follow-up appointments will be necessary to evaluate the surgical site and ensure that the patient is healing properly. Additionally, laboratory analysis of the removed calculus will provide valuable information for future management and prevention of stone recurrence.