CPT® Code 50236

An open nephrectomy with total ureterectomy and bladder cuff excision is a surgical procedure that involves the removal of a kidney along with its associated ureter and a portion of the bladder. This procedure is typically indicated in cases where there is a need to address significant renal pathology, such as tumors or severe infections. The surgery is performed through a wide flank incision, which is strategically placed below the lower border of the ribs or near the 11th or 12th rib, allowing for optimal access to the kidney and ureter. In some cases, an anterior subcostal approach may be utilized as an alternative access point. During the procedure, a Foley catheter is inserted to facilitate bladder drainage. The surgical team carefully isolates the renal artery and vein, ligating and dividing them to free the kidney from its vascular connections. The kidney is then meticulously dissected from the surrounding tissues and removed. Following the nephrectomy, the entire ureter is excised along with a section of the bladder at the ureterovesical junction (UVJ). This involves dissecting the ureter free from surrounding structures, incising the bladder just below the UVJ, and removing the bladder cuff. The bladder incision is subsequently closed, and measures are taken to control any bleeding, with drains placed as necessary before closing the incisions. It is important to note that if the procedure is performed through a single incision, a different CPT® code (50234) is reported, whereas CPT® code 50236 is specifically used when the nephrectomy is conducted through a flank or subcostal incision with a separate incision for the ureter and bladder cuff removal.