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Official Description

Nephrorrhaphy, suture of kidney wound or injury

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Nephrorrhaphy, as defined by CPT® Code 50500, refers to a surgical procedure aimed at repairing a wound or injury to the kidney through suturing. This open surgical intervention is necessary when the kidney sustains trauma, which may result from various causes, including accidents or surgical complications. The procedure begins with the creation of a flank incision, allowing the surgeon to access the kidney directly. Once the kidney is exposed, the surgeon carefully identifies the specific area of injury or lesion that requires repair. The actual repair involves the meticulous placement of sutures to close the wound, ensuring that the kidney can heal properly. Following the suturing, the operative site undergoes irrigation to cleanse the area and is thoroughly inspected for any additional injuries that may not have been initially apparent. If further injuries are discovered, they are also addressed and repaired. Control of any bleeding is a critical aspect of the procedure to prevent complications. In some cases, drains may be inserted into the operative site to facilitate the removal of fluids and prevent accumulation, and finally, the surgical wound is closed around these drains to complete the procedure.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

Nephrorrhaphy is indicated in cases where there is a wound or injury to the kidney that requires surgical intervention to repair. The following conditions may warrant this procedure:

  • Traumatic Kidney Injury A direct injury to the kidney resulting from accidents, falls, or blunt force trauma.
  • Post-Surgical Complications Injuries to the kidney that may occur as a result of previous surgical procedures in the abdominal or renal area.
  • Renal Lacerations Cuts or tears in the kidney tissue that necessitate surgical repair to restore function and integrity.

2. Procedure

The procedure of nephrorrhaphy involves several critical steps to ensure effective repair of the kidney injury.

  • Step 1: Flank Incision The surgeon begins by making a flank incision, which is a surgical cut made on the side of the abdomen. This incision provides access to the kidney, allowing the surgeon to visualize and operate on the affected area.
  • Step 2: Exposure of the Kidney After the incision is made, the surgeon carefully dissects through the layers of tissue to expose the injured kidney. This step is crucial as it allows for a clear view of the injury and the surrounding structures.
  • Step 3: Identification of the Lesion Once the kidney is exposed, the surgeon identifies the specific area of the lesion or injury. This identification is essential for determining the appropriate repair technique and ensuring that all damaged tissue is addressed.
  • Step 4: Suturing the Wound The next step involves the actual repair of the kidney wound. The surgeon uses sutures to close the injury, ensuring that the kidney is properly aligned and that the tissue can heal effectively.
  • Step 5: Irrigation and Inspection After suturing, the operative site is irrigated to remove any debris or contaminants. The surgeon then inspects the area for any additional injuries that may require attention, ensuring a thorough evaluation of the kidney.
  • Step 6: Control of Bleeding It is critical to control any bleeding that may occur during the procedure. The surgeon takes necessary measures to ensure hemostasis, preventing complications related to excessive blood loss.
  • Step 7: Placement of Drains In some cases, drains may be placed in the operative site to facilitate the removal of fluids and prevent fluid accumulation, which can lead to infection or other complications.
  • Step 8: Closure of the Surgical Wound Finally, the surgical wound is closed around the drains, if placed, ensuring that the incision is properly sealed to promote healing.

3. Post-Procedure

Post-procedure care following nephrorrhaphy involves monitoring the patient for any signs of complications, such as infection or bleeding. The surgical site should be kept clean and dry, and any drains that were placed may need to be monitored for output. Patients are typically advised on activity restrictions to allow for proper healing of the kidney and surrounding tissues. Follow-up appointments are essential to assess the recovery process and ensure that the kidney is functioning properly after the repair.

Short Descr REPAIR OF KIDNEY WOUND
Medium Descr NEPHRORRHAPHY SUTURE KIDNEY WOUND/INJURY
Long Descr Nephrorrhaphy, suture of kidney wound or injury
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) 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 112 - Other OR therapeutic procedures of urinary tract
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).
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).
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.
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).
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)
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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Pre-1990 Added Code added.
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