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Official Description

Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; thoracic approach

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 50526 involves the closure of a nephrovisceral fistula, which is an abnormal connection between the kidney and another internal organ, such as the colon. This condition often arises due to complications from renal stones, infections like tuberculosis, or injuries sustained during medical procedures such as percutaneous interventions or lithotripsy. The closure of the fistula is performed through a thoracic surgical approach, which is determined by the specific location of the fistulous tract. During the procedure, the kidney and ureter are surgically exposed, allowing for direct access to the fistula. A catheter is inserted into the ureter, and a radiopaque contrast agent is injected to visualize the fistulous tract clearly. The surgeon then meticulously traces the fistula to its entry point into the affected organ, where it is securely ligated and divided. Following this, the involved organ is repaired as necessary, and the origin of the fistula within the kidney is also closed to prevent any further complications. It is important to note that for an abdominal approach to this procedure, CPT® Code 50525 should be used, while CPT® Code 50526 is specifically designated for the thoracic approach.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The closure of nephrovisceral fistula, as described by CPT® Code 50526, is indicated in the following situations:

  • Renal Stones The presence of renal stones can lead to the formation of a fistulous tract between the kidney and another organ, necessitating surgical intervention.
  • Tuberculosis Renal tuberculosis may cause the development of a fistula, requiring closure to restore normal anatomical function.
  • Injury from Percutaneous Procedures Accidental injury during procedures such as percutaneous nephrolithotomy can result in a nephrovisceral fistula that requires surgical repair.
  • Lithotripsy Complications Complications arising from lithotripsy, a procedure used to break down kidney stones, may also lead to the formation of a fistulous tract.

2. Procedure

The procedure for the closure of a nephrovisceral fistula involves several critical steps:

  • Step 1: Surgical Exposure The first step involves making an incision to expose the kidney and ureter. This surgical access is essential for visualizing the fistulous tract and performing the necessary repairs.
  • Step 2: Catheter Insertion A catheter is then inserted into the ureter. This catheterization is crucial for the next step, as it allows for the introduction of a radiopaque substance.
  • Step 3: Radiopaque Substance Injection A radiopaque contrast agent is injected through the catheter. This imaging technique helps to clearly delineate the fistulous tract, allowing the surgeon to trace its path accurately.
  • Step 4: Tracing the Fistula The surgeon follows the fistulous tract down to its entry point into the involved organ, such as the colon. This step is vital for ensuring that the entire fistula is addressed during the procedure.
  • Step 5: Ligation and Division Once the entry point is located, the fistula is carefully suture ligated and divided. This step effectively closes the abnormal connection between the kidney and the other organ.
  • Step 6: Organ Repair After the fistula is divided, the involved organ is repaired as necessary to restore its function and integrity.
  • Step 7: Closure of the Kidney Finally, the origin of the fistula within the kidney is closed to prevent any recurrence of the fistulous tract.

3. Post-Procedure

Post-procedure care following the closure of a nephrovisceral fistula typically involves monitoring for any complications, such as infection or leakage from the surgical site. Patients may require pain management and should be observed for signs of proper healing. Follow-up imaging may be necessary to ensure that the fistula has been successfully closed and that there are no residual issues. The recovery period can vary depending on the individual patient's health and the complexity of the procedure, but patients are generally advised to avoid strenuous activities during the initial recovery phase.

Short Descr CLOSE NEPHROVISCERAL FISTULA
Medium Descr CLSR NEPHROVISCERAL FISTULA W/VISC RPR THRC APPR
Long Descr Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; thoracic approach
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) 0 - Co-surgeons not permitted for this procedure.
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
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Pre-1990 Added Code added.
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