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The procedure described by CPT® Code 50557 involves renal endoscopy performed through an already established nephrostomy or pyelostomy. This technique is utilized to access the kidney for various diagnostic and therapeutic purposes, including the fulguration of lesions or obtaining biopsies. The process begins with the removal of the external drainage bag from the nephrostomy or pyelostomy tube, allowing for direct access to the urinary tract. A guidewire is then advanced through the tube, facilitating the removal of the nephrostomy tube itself. Following this, a series of dilators are utilized to expand the tract, enabling the insertion of a renal endoscope. This endoscope allows for a thorough examination of the kidney's internal structures. During the procedure, sterile saline or other solutions may be used for irrigation, and diagnostic or therapeutic agents can be instilled into the kidney. Additionally, contrast material may be introduced for radiopyelography, which is a separate reportable service. After the examination, if necessary, biopsy forceps can be introduced to collect tissue samples, or an electrocautery tool may be used to destroy lesions or incise the renal pelvis or calyces. The procedure concludes with the removal of all instruments, replacement of the nephrostomy tube, and reattachment of the external drainage bag, ensuring that the patient’s drainage system is restored to its functional state.
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The renal endoscopy procedure described by CPT® Code 50557 is indicated for various conditions and symptoms related to the kidney. These may include:
The procedure for renal endoscopy through an established nephrostomy or pyelostomy involves several detailed steps:
Post-procedure care following renal endoscopy through nephrostomy or pyelostomy includes monitoring the patient for any complications such as bleeding or infection. Patients may be advised to maintain hydration and report any unusual symptoms, such as fever or increased pain. Follow-up imaging or evaluations may be necessary to assess the outcomes of the procedure and ensure that the kidney is functioning properly. Additionally, instructions regarding the care of the nephrostomy site and drainage system should be provided to the patient to prevent complications.
| Short Descr | KIDNEY ENDOSCOPY & TREATMENT | Medium Descr | RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BI | Long Descr | Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies 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. | Endoscopic Base Code | 50551 Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8I - Endoscopy - 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). | LT | Left side (used to identify procedures performed on the left side of the body) | 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. | 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.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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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| 2013-01-01 | Changed | Medium Descriptor changed. |
| Pre-1990 | Added | Code added. |
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