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A pyelotomy is a surgical procedure that involves making an incision into the renal pelvis, which is the central cavity of the kidney responsible for collecting urine from the calyces. This procedure is typically performed to address issues such as the presence of calculi, or stones, within the renal pelvis. The renal pelvis serves as a conduit for urine, allowing it to drain into the ureter. During a pyelotomy, a skin incision is made over the kidney, followed by the incision of Gerota's fascia and dissection of the perirenal fat to access the kidney. Surgeons carefully identify and control blood vessels by encircling them with loops to prevent excessive bleeding. The kidney and ureter are then exposed for visual examination, allowing the surgeon to trace the ureter upward to the ureteropelvic junction (UPJ) and locate the renal pelvis. Once the posterior aspect of the renal pelvis is accessed, it is incised to facilitate exploration for any signs of disease or injury. In cases where a pyelostomy is required, a tube is placed into the renal pelvis to aid in urine drainage. The procedure may involve the removal of a single calculus using specialized stone forceps or, in cases of multiple small stones, a coagulum pyelolithotomy technique may be employed. This technique involves creating a clot that encapsulates the small stones, which is achieved by injecting thrombin and calcium chloride solution into the renal pelvis prior to incision. The formation of the clot allows for the effective removal of the stones during the procedure, ensuring that the renal pelvis is cleared of obstructions and functioning properly.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure of pyelotomy with removal of calculus is indicated for the following conditions:
The procedure of pyelotomy with removal of calculus involves several critical steps:
After the pyelotomy with removal of calculus, patients may require monitoring for any complications such as bleeding or infection. Post-operative care typically includes pain management and the potential placement of a drainage tube to facilitate urine flow from the kidney. Patients are advised to follow up with their healthcare provider to ensure proper healing and to monitor kidney function. Recovery time may vary depending on the extent of the procedure and the patient's overall health, but most individuals can expect to resume normal activities within a few weeks, barring any complications.
| Short Descr | PYELOTOMY W/REMOVAL CALCULUS | Medium Descr | PYELOTOMY WITH REMOVAL CALCULUS | Long Descr | Pyelotomy; with removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy) | 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) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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 |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2023-01-01 | Note | Short and medium descriptions changed. |
| Pre-1990 | Added | Code added. |
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