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The procedure described by CPT® Code 50575 involves a renal endoscopy performed through a nephrotomy or pyelotomy, which is a surgical incision into the kidney or renal pelvis. This procedure allows for direct visualization and intervention within the kidney. During the process, a renal endoscope is inserted through the incision to examine the kidney's internal structures. The use of sterile saline or other solutions may be employed for irrigation purposes, which helps to clear the field of view and maintain a sterile environment. Additionally, a diagnostic or therapeutic solution may be instilled into the kidney to treat specific conditions or to prepare for further imaging, such as ureteropyelography, which assesses the ureteropelvic junction. The procedure also includes the use of a cystoscope, which is introduced through the urethra to examine the bladder. A guidewire is then passed through the ureter to the obstructed area of the renal pelvis in a retrograde manner, allowing for the advancement of a ureteroscope into the ureter for further examination. In some cases, a second guidewire may be introduced from the renal pelvis into the ureter in an antegrade fashion to facilitate the procedure. A critical component of this procedure is the endopyelotomy, where an incision is made in the inner and middle layers of the ureteral pelvic junction using specialized endoscopic tools, while preserving the outer fibrous layer. This incision aims to relieve any obstruction at the ureteropelvic junction. Following the incision, a balloon dilator may be utilized to widen the area, and an endopyelotomy stent is placed to ensure that the incision remains open during the healing process. Finally, any guidewires and surgical instruments are removed, and a nephrostomy tube may be inserted if necessary before closing the kidney incision. This comprehensive approach allows for effective treatment of conditions affecting the kidney and ureter while minimizing invasiveness.
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The renal endoscopy procedure described by CPT® Code 50575 is indicated for various conditions affecting the kidney and ureter, particularly those involving obstruction at the ureteropelvic junction. The following are specific indications for performing this procedure:
The procedure involves several critical steps to ensure effective intervention and patient safety. Each step is detailed as follows:
After the completion of the renal endoscopy procedure, patients may require specific post-procedure care to ensure proper recovery. Monitoring for any signs of complications, such as infection or bleeding, is essential. Patients may be advised to follow up with their healthcare provider to assess the effectiveness of the procedure and to monitor kidney function. Pain management may be necessary, and patients should be informed about any potential symptoms to watch for, such as changes in urine output or color. Additionally, instructions regarding activity restrictions and care of any inserted nephrostomy tube should be provided to ensure optimal healing and recovery.
| Short Descr | KIDNEY ENDOSCOPY | Medium Descr | RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY | Long Descr | Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent) | 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) | 1 - Statutory 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 | 50570 Renal endoscopy through nephrotomy or pyelotomy, 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 | Non office-based surgical procedure added in CY 2008 or later; 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 |
| 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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. | 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.) | 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) |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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