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The procedure described by CPT® Code 50360 refers to renal allotransplantation, specifically the implantation of a kidney graft without the removal of the recipient's native kidney. In this surgical procedure, a kidney, which may be obtained from either a deceased (cadaver) or living donor, is transplanted into a patient who requires a new kidney due to renal failure or other kidney-related conditions. The operation begins with an incision in the lower abdomen, allowing access to the retroperitoneal space where the iliac blood vessels are located. The surgeon carefully dissects and prepares these blood vessels to facilitate the connection of the donor kidney's blood supply. The procedure involves meticulous steps, including the ligation and division of lymphatic vessels, dissection of the iliac blood vessels, and the application of vascular clamps to control blood flow during the anastomosis. The renal vein and renal artery from the donor kidney are then surgically connected to the recipient's external iliac vein and internal or external iliac artery, respectively. If the donor kidney has multiple veins or arteries, each is connected separately to ensure adequate blood supply. Following the vascular connections, the ureter from the donor kidney is prepared for attachment to the recipient's bladder, which involves exposing and incising the bladder dome. The ureter is then trimmed and anastomosed to the bladder, with the possibility of placing a temporary stent to maintain patency at the connection site. Finally, the transplanted kidney is positioned in the parapsoas fossa, ensuring that the blood vessels and ureter are not kinked, and the surgical incisions are closed. This procedure is reported using CPT® Code 50360 when the transplant is performed without nephrectomy of the recipient's kidney.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure of renal allotransplantation, as described by CPT® Code 50360, is indicated for patients who are experiencing severe renal failure or end-stage renal disease. This condition may arise from various underlying causes, including but not limited to chronic glomerulonephritis, diabetic nephropathy, hypertension-related kidney damage, or polycystic kidney disease. The transplantation of a kidney is performed to restore kidney function, improve the patient's quality of life, and reduce the need for dialysis or other renal replacement therapies.
The renal allotransplantation procedure begins with the surgeon making an incision in the lower abdomen to access the retroperitoneal space. This incision allows the surgeon to enter the abdominal cavity and reach the iliac blood vessels. The transversalis fascia is incised, and the peritoneum is retracted medially to expose the iliac vessels. The lymphatic vessels surrounding these blood vessels are carefully ligated and divided to prevent complications during the surgery. Next, the surgeon dissects the iliac blood vessels free from surrounding tissue, starting from just above the iliac lymph nodes down to the bifurcation of the external and internal iliac artery. Vascular clamps are then applied to control blood flow. The external iliac vein is incised, and the renal vein from the donor kidney is anastomosed to this vein. If the donor kidney has more than one renal vein, each vein is anastomosed separately to ensure proper venous drainage. Following the venous anastomosis, the prepared renal artery is anastomosed to either the internal or external iliac artery. In cases where the donor kidney has multiple renal arteries, separate incisions are made for each artery, and they are anastomosed to different sites on the iliac artery. Once the vascular connections are established, the vascular clamps are released, and the anastomosis sites are inspected for any bleeding, which is controlled as necessary. The next step involves preparing the ureter from the donor kidney for anastomosis to the recipient's bladder. The dome of the bladder is exposed and incised, and the ureter is trimmed to the appropriate length. The end of the ureter is spatulated to match the opening in the bladder, and the mucosa of both the bladder and ureter are anastomosed. The detrusor muscle layer over the ureter is then closed, and a temporary stent may be placed to ensure patency at the anastomosis site. Finally, the transplanted kidney is positioned in the parapsoas fossa, ensuring that there is no kinking of the blood vessels or ureter. The surgical incisions are then closed, completing the procedure.
After the renal allotransplantation procedure, patients are typically monitored closely for any signs of complications, such as bleeding, infection, or rejection of the transplanted kidney. Post-operative care may include the administration of immunosuppressive medications to prevent organ rejection, as well as pain management and monitoring of kidney function through laboratory tests. Patients may also require follow-up visits to assess the function of the transplanted kidney and to adjust medications as necessary. Recovery time can vary, but patients are generally advised to avoid strenuous activities for a period of time to allow for proper healing.
| Short Descr | RNL ALTRNSPLJ W/O RCP NFRCT | Medium Descr | RENAL ALTRNSPLJ IMPLTJ GRF W/O RCP NEPHRECTOMY | Long Descr | Renal allotransplantation, implantation of graft; without recipient nephrectomy | 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) | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | Team Surgery (66) | 2 - Team surgeons permitted; pay by report. | 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 | 105 - Kidney transplant |
| 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) | 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. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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. | 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). | 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 | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 66 | Surgical team: under some circumstances, highly complex procedures (requiring the concomitant services of several physicians or other qualified health care professionals, often of different specialties, plus other highly skilled, specially trained personnel, various types of complex equipment) are carried out under the "surgical team" concept. such circumstances may be identified by each participating individual with the addition of modifier 66 to the basic procedure number used for reporting services. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | AG | Primary physician | 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 | GA | Waiver of liability statement issued as required by payer policy, individual case | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | Q3 | Live kidney donor surgery and related services | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 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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| 2025-01-01 | Changed | Short Description changed. |
| 2005-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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