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The procedure described by CPT® Code 50395 involves the introduction of a guide into the renal pelvis and/or ureter, accompanied by dilation to create a nephrostomy tract through a percutaneous approach. This procedure is typically performed in the flank region, where the skin over the kidney is first cleansed to minimize the risk of infection. A local anesthetic is then administered to ensure patient comfort during the procedure. Following this, a needle is carefully inserted, allowing for the advancement of a guidewire through the skin and into the renal pelvis or ureter. This step is crucial as it provides a pathway for subsequent instruments. The procedure is conducted under radiologic supervision, which is separately reportable, ensuring that the placement of the guidewire is accurately monitored. Once the guidewire is in place, a series of dilators are advanced over it to gradually enlarge the tract, facilitating the establishment of a nephrostomy. The dilation process is essential for creating an adequately sized tract, and once the desired diameter is achieved, the dilator is removed, leaving the nephrostomy tract ready for further intervention or drainage as needed.
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The procedure associated with CPT® Code 50395 is indicated for various clinical scenarios where access to the renal pelvis or ureter is necessary. The following conditions may warrant the performance of this procedure:
The procedure begins with the preparation of the patient, where the skin in the flank region over the kidney is thoroughly cleansed to reduce the risk of infection. Following this, a local anesthetic is infiltrated to ensure the patient remains comfortable throughout the procedure. A needle is then carefully passed through the skin, allowing for the introduction of a guidewire. This guidewire is advanced under radiologic supervision, which is a critical step to ensure accurate placement within the renal pelvis or ureter. Once the guidewire is correctly positioned, a series of dilators are advanced over the guidewire. These dilators are used to gradually enlarge the tract, which is essential for establishing a nephrostomy tract. The dilation process is performed meticulously to achieve the required diameter for the nephrostomy. After the desired size is reached, the dilator is removed, leaving the nephrostomy tract established and ready for further use.
After the completion of the nephrostomy tract establishment, post-procedure care is crucial for patient recovery and monitoring. Patients are typically observed for any immediate complications, such as bleeding or infection. It is important to monitor the nephrostomy site for signs of leakage or other issues. Patients may also require imaging studies to confirm the proper placement of the nephrostomy tube and ensure that urine is draining appropriately. Instructions regarding care of the nephrostomy site, signs of infection, and follow-up appointments should be provided to the patient to ensure a smooth recovery process. Additionally, the healthcare team may discuss any necessary adjustments to the patient's treatment plan based on the outcomes of the procedure.
| Short Descr | CREATE PASSAGE TO KIDNEY | Medium Descr | INTRO GUIDE PELVIS&/URETER W/DILAT NFROS TRACT | Long Descr | Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | 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) | 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. | 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) | P1G - Major procedure - Other | MUE | Not applicable/unspecified. | CCS Clinical Classification | 103 - Nephrotomy and nephrostomy |
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