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Official Description

Backbench standard preparation of living donor renal allograft (open or laparoscopic) prior to transplantation, including dissection and removal of perinephric fat and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 50325 refers to the backbench standard preparation of a living donor renal allograft, which can be performed through either open or laparoscopic techniques prior to transplantation. This procedure is essential for ensuring that the kidney is adequately prepared for successful transplantation. The process begins with the careful dissection and removal of perinephric fat, which is the fatty tissue surrounding the kidney. This step is crucial as it helps to expose the kidney and its associated structures for further preparation. Additionally, the procedure involves the meticulous preparation of the ureters, renal veins, and renal arteries. During this preparation, branches of these vessels may need to be ligated as necessary to prevent complications during and after the transplant. The overall goal of this procedure is to ensure that the renal allograft is in optimal condition for transplantation, thereby enhancing the likelihood of a successful outcome for the recipient.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The backbench standard preparation of a living donor renal allograft is indicated for the following:

  • Living Donor Transplantation This procedure is performed when a kidney is harvested from a living donor for transplantation into a recipient.

2. Procedure

The procedure for backbench preparation of a living donor renal allograft involves several critical steps to ensure the kidney is ready for transplantation.

  • Step 1: Unpacking and Initial Preparation The kidney is unpackaged and transferred to a back table basin, where it is placed in iced Ringer's lactate solution. This initial step is vital for preserving the kidney's viability during the preparation process.
  • Step 2: Culturing Preservation Fluid Cultures are taken from the preservation fluid and sent to the laboratory for analysis. This step helps in assessing the condition of the kidney and any potential infections.
  • Step 3: Dissection of Perinephric Fat The perinephric fat and surrounding tissue are carefully dissected off the external surface of the kidney. This dissection is crucial for exposing the kidney and its vascular structures for further preparation.
  • Step 4: Adrenal Gland Removal The adrenal gland is excised during this step to prevent complications during transplantation.
  • Step 5: Inspection and Ligation of Blood Vessels The kidney is thoroughly inspected, and all open ends of small blood vessels are suture ligated to prevent post-transplant bleeding. This step is essential for ensuring hemostasis.
  • Step 6: Ligation of Lymphatic Vessels Lymphatic vessels are also suture ligated to prevent the formation of lymphoceles after transplantation, which can complicate recovery.
  • Step 7: Addressing Large Blood Vessels The gonadal, adrenal, and any lumbar vein branches are divided and ligated. The renal vein is then trimmed, and if any reconstruction is necessary, it will be reported separately.
  • Step 8: Evaluation of Renal Arteries The renal arteries are evaluated, as some donors may have a single renal artery while others may have multiple. The renal arteries are trimmed, and branches are ligated as needed. Any required reconstruction of the renal arteries will also be reported separately.
  • Step 9: Ureter Preparation The ureter is prepared while leaving as much surrounding tissue as possible undisturbed to prevent damage to the vascular structures. This careful handling is crucial for maintaining the integrity of the ureter.
  • Step 10: Flushing Renal Vessels Finally, the renal vessels are flushed with Ringer's lactate solution to identify any vascular defects or leaks that may require additional preparation or repair. This step ensures that the kidney is fully prepared for transplantation.

3. Post-Procedure

After the backbench preparation of the living donor renal allograft, the kidney is ready for transplantation. It is essential to monitor the kidney for any signs of vascular defects or complications that may arise from the preparation process. The kidney should be kept in a suitable preservation solution until it is transplanted into the recipient. Proper handling and timely transplantation are critical to ensuring the success of the procedure and the health of the recipient.

Short Descr PREP DONOR RENAL GRAFT
Medium Descr BKBENCH PREPJ LIVING RENAL DONOR ALLOGRAFT
Long Descr Backbench standard preparation of living donor renal allograft (open or laparoscopic) prior to transplantation, including dissection and removal of perinephric fat and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary
Status Code Carriers Price the Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
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 104 - Nephrectomy, partial or complete
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).
GC This service has been performed in part by a resident under the direction of a teaching physician
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).
RT Right side (used to identify procedures performed on the right side of the body)
Q3 Live kidney donor surgery and related services
LT Left side (used to identify procedures performed on the left side of the body)
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.
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.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
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.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
Date
Action
Notes
2005-01-01 Added First appearance in code book in 2005.
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