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The procedure described by CPT® Code 50520 involves the surgical closure of a nephrocutaneous or pyelocutaneous fistula, which is an abnormal connection between the kidney or the ureteropelvic junction (UPJ) and the skin. This type of fistula typically manifests as a sinus tract that extends from the kidney or UPJ to the external skin surface. The formation of such fistulous tracts is often attributed to underlying conditions such as kidney stones or infections like tuberculosis. Additionally, they may arise as a result of complications from percutaneous procedures or lithotripsy, which is a treatment that uses shock waves to break up stones in the kidney or ureter. To accurately locate the termination site of the fistulous tract within the abdomen, a radiopaque substance is injected into the fistula. This imaging technique allows for precise identification of the tract's pathway. Once the site is determined, the surgical procedure involves the use of suture ligation to effectively close the open sinus tract. In some cases, additional techniques such as fulguration, which involves the use of heat to destroy tissue, or the injection of fibrin glue, a biological adhesive, may be employed to ensure a secure closure of the fistula. This procedure is critical for preventing further complications and promoting healing in patients with these types of fistulas.
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The closure of nephrocutaneous or pyelocutaneous fistulas is indicated in several clinical scenarios, particularly when the fistulous tract leads to complications or symptoms that require surgical intervention. The following conditions may warrant this procedure:
The procedure for closing a nephrocutaneous or pyelocutaneous fistula involves several critical steps to ensure successful closure and healing. The following outlines the procedural steps:
After the closure of a nephrocutaneous or pyelocutaneous fistula, patients typically require careful monitoring and follow-up care. Post-procedure care may include pain management, wound care, and monitoring for any signs of infection or complications. Patients are often advised to avoid strenuous activities during the initial recovery period to facilitate healing. Follow-up imaging may be necessary to ensure that the fistula has been successfully closed and that there are no residual issues. The expected recovery time can vary based on the individual patient's condition and the complexity of the procedure performed.
| Short Descr | CLOSE KIDNEY-SKIN FISTULA | Medium Descr | CLOSURE NEPHROCUTANEOUS/PYELOCUTANEOUS FISTULA | Long Descr | Closure of nephrocutaneous or pyelocutaneous fistula | 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 |
| 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). | 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.) | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| Pre-1990 | Added | Code added. |
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