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A donor nephrectomy is a surgical procedure performed to remove a kidney from a living donor for transplantation purposes. This specific procedure, identified by CPT® Code 50320, involves an open surgical approach and includes the cold preservation of the donor kidney. The term "cold preservation" refers to the technique used to maintain the viability of the kidney during the time it is removed from the donor until it is transplanted into the recipient. The procedure begins with the identification and incision of the lateral line of Toldt, which is a peritoneal reflection that allows access to the kidney. The peritoneum, a membrane lining the abdominal cavity, is then mobilized to visualize the anterior surface of the kidney. During the surgery, the colon is carefully mobilized and rolled medially to provide better access to the kidney. The colorenal ligaments, which support the kidney, are divided, and Gerota's fascia, a layer of connective tissue surrounding the kidney, is exposed. The ureter, which carries urine from the kidney to the bladder, along with the surrounding vascular structures, is identified and retracted to enhance visibility of the lower pole of the kidney and the renal hilum, the area where blood vessels and nerves enter and exit the kidney. The procedure requires meticulous dissection to ensure that the renal artery and vein are properly identified and preserved while leaving certain attachments intact to prevent torsion and vascular damage. Once the kidney is fully mobilized and detached from its vascular supply, it is removed from the donor's body. The kidney may then be perfused with a cold preservation solution or placed on ice to ensure its viability until it can be transplanted into the recipient. This detailed process is critical for the successful transplantation of the kidney and the overall success of the transplant surgery.
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The donor nephrectomy procedure is indicated for the following conditions:
The donor nephrectomy procedure involves several critical steps to ensure the safe and effective removal of the kidney from the living donor.
Post-procedure care for the living donor includes monitoring for any complications related to the surgery, such as bleeding or infection. The donor will typically be observed in a recovery area before being transferred to a hospital room for further monitoring. Pain management is an essential aspect of post-operative care, and the donor may be prescribed medications to manage discomfort. The expected recovery time varies, but most donors can expect to return to normal activities within a few weeks, depending on their overall health and the specifics of the surgical procedure. Follow-up appointments will be scheduled to ensure proper healing and to monitor the donor's kidney function.
| Short Descr | REMOVE KIDNEY LIVING DONOR | Medium Descr | DONOR NEPHRECTOMY OPEN LIVING DONOR | Long Descr | Donor nephrectomy (including cold preservation); open, from living donor | 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) | N - Kidney Donor | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 104 - Nephrectomy, partial or complete |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 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). | 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) | Q3 | Live kidney donor surgery and related services | RT | Right side (used to identify procedures performed on the right side of the body) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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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| 2011-01-01 | Changed | Short description changed. |
| 2005-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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