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The procedure described by CPT® Code 50541 involves a laparoscopic surgical technique aimed at the ablation of renal cysts. In simpler terms, this means that a physician uses minimally invasive methods to destroy cysts or mass lesions located in the kidney. The term "ablation" refers to the process of removing or destroying tissue, and in this context, it can be achieved through various advanced techniques. These techniques include cryoablation, which uses extreme cold to freeze and destroy the lesion; radiofrequency ablation (RFA), which employs heat generated by radio waves; high-intensity focused ultrasound (HIFU), which utilizes focused sound waves to create heat and induce cavitation; and laser thermal ablation, which uses laser energy to target and destroy the tissue. During the procedure, the physician creates a pneumoperitoneum, which is the introduction of gas into the abdominal cavity to create space for surgical manipulation. Trocars, which are specialized instruments, are inserted to allow access to the abdominal cavity. The laparoscope, a camera that provides visualization of the internal structures, is introduced through the umbilical port. The surgeon then mobilizes the peritoneum over the kidney to visualize the anterior surface of the kidney, where the lesion is identified. Once the lesion is located, the surgeon inserts one or more cryosurgical probes or other ablation instruments into the cyst or mass. If cryoablation is selected, the procedure involves initiating a freeze-thaw cycle, where the ice ball formed during the freezing process is carefully monitored using ultrasound to ensure it adequately encompasses the lesion. This cycle may be repeated to ensure complete ablation. In cases where RFA is utilized, the surgeon selects the appropriate electrode based on the lesion's characteristics and activates the device to heat and destroy the tissue. Similarly, laser thermal ablation and HIFU are employed to achieve the same goal of lesion destruction. After all targeted lesions have been treated, the surgical instruments are removed, any bleeding is controlled, drains may be placed if necessary, and the incisions are closed around the drains. This procedure is specifically coded as 50541 for the ablation of renal cysts, while a different code, 50542, is designated for the ablation of other renal mass lesions.
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The procedure coded as CPT® 50541 is indicated for the treatment of renal cysts. These cysts may present as symptomatic or asymptomatic lesions within the kidney, and the decision to perform ablation is typically based on factors such as the size, number, and characteristics of the cysts, as well as the patient's overall health and specific clinical circumstances.
The laparoscopic ablation of renal cysts involves several key procedural steps that ensure effective treatment. First, the surgeon establishes pneumoperitoneum, which is the introduction of gas into the abdominal cavity to create a working space. Following this, trocars are inserted to facilitate access to the abdominal cavity. The laparoscope, a specialized camera, is then introduced through the umbilical port, allowing the surgeon to visualize the internal structures of the abdomen and kidney. Next, the surgeon mobilizes the peritoneum over the kidney to gain access to the anterior surface of the kidney, where the cyst or lesion is identified. Once the lesion is located, the surgeon inserts one or more cryosurgical probes or other ablation instruments directly into the cyst. If cryoablation is the chosen method, the surgeon initiates the first freeze-thaw cycle, creating an ice ball around the lesion. This ice ball is monitored using ultrasound to ensure it extends beyond the margins of the cyst, confirming adequate coverage for effective ablation. A second freeze-thaw cycle may be performed to ensure complete destruction of the cyst. In cases where radiofrequency ablation (RFA) is utilized, the surgeon selects the appropriate electrode needle or array based on the lesion's size and shape. The RFA device is then activated, delivering thermal energy to the lesion to achieve ablation. Alternatively, if laser thermal ablation is performed, a laser is used to generate heat to destroy the cyst. High-intensity focused ultrasound (HIFU) may also be employed, utilizing focused sound waves to create heat and induce cavitation within the lesion. After all targeted lesions have been treated, the surgeon carefully removes the surgical instruments, controls any bleeding that may have occurred, and places drains if necessary. Finally, the portal incisions are closed around the drains to complete the procedure.
Post-procedure care following the laparoscopic ablation of renal cysts typically involves monitoring the patient for any immediate complications, such as bleeding or infection. Patients may be advised to rest and limit physical activity for a specified period to promote healing. Follow-up appointments are essential to assess the success of the procedure and to monitor for any recurrence of cysts or development of new lesions. The specific recovery timeline and any additional care instructions will depend on the individual patient's condition and the extent of the procedure performed.
| Short Descr | LAPARO ABLATE RENAL CYST | Medium Descr | LAPAROSCOPY SURG ABLATION RENAL CYSTS | Long Descr | Laparoscopy, surgical; ablation of renal cysts | 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) | 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 | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 112 - Other OR therapeutic procedures of urinary tract |
This is a primary code that can be used with these additional add-on codes.
| 49327 | Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure) |
| 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). | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | 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) | 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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| 2000-01-01 | Added | First appearance in code book in 2000. |
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