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The procedure described by CPT® Code 50365 refers to renal allotransplantation, which is the surgical implantation of a kidney graft from a donor into a recipient who has end-stage renal disease or other significant kidney dysfunction. This procedure involves the removal of the recipient's native kidney, which is performed concurrently with the transplantation of the donor kidney. The surgery 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 vessels to facilitate the anastomosis, or connection, of the donor kidney's blood vessels to the recipient's vascular system. During the procedure, the surgeon ligates and divides lymphatic vessels surrounding the iliac blood vessels to ensure a clear surgical field. The external iliac vein is then incised, and the renal vein from the donor kidney is connected to it. If the donor kidney has multiple renal veins, each is anastomosed separately. The renal artery from the donor kidney is subsequently connected to either the internal or external iliac artery, with similar considerations for multiple renal arteries. After establishing the vascular connections, the ureter from the donor kidney is prepared for anastomosis to the bladder. This involves exposing and incising the dome of the bladder, trimming the ureter to the appropriate length, and ensuring a secure connection between the ureter and bladder. A temporary stent may be placed to maintain patency at the anastomosis site. The donor kidney is positioned in the parapsoas fossa, ensuring that there is no kinking of the blood vessels or ureter. Finally, the surgical incisions are closed, completing the procedure. This code is specifically used when the recipient's kidney is removed during the transplant operation, distinguishing it from similar procedures where the native kidney remains intact.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 50365 is indicated for patients who require renal allotransplantation due to various conditions that lead to significant kidney dysfunction. These indications may include, but are not limited to:
The procedure for renal allotransplantation with recipient nephrectomy involves several critical steps, each essential for the successful transplantation of the donor kidney. The process 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 gain visibility of the iliac blood vessels. The transversalis fascia is incised, and the peritoneum is retracted medially to expose the iliac vessels adequately.
After the completion of the renal allotransplantation with recipient nephrectomy, the patient will require careful monitoring and post-operative care. This includes managing pain, monitoring for signs of infection, and ensuring proper kidney function through laboratory tests. The patient may also need to stay in the hospital for several days for observation and to receive immunosuppressive medications to prevent organ rejection. Follow-up appointments will be necessary to assess the function of the transplanted kidney and to adjust medications as needed. Additionally, the surgical site will be monitored for any complications, such as bleeding or infection, and drains may be placed as needed to facilitate recovery.
| Short Descr | RNL ALTRNSPLJ W/RCP NFRCT | Medium Descr | RENAL ALTRNSPLJ IMPLTJ GRF W/RCP NEPHRECTOMY | Long Descr | Renal allotransplantation, implantation of graft; with 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) | 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) | 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 |
| 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. | 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). | 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). | 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. | 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). | 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). | 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 | 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) |
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| 2025-01-01 | Changed | Short Description changed. |
| Pre-1990 | Added | Code added. |
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