CPT® Code 50520

The procedure described by CPT® Code 50520 involves the surgical closure of a nephrocutaneous or pyelocutaneous fistula, which is an abnormal connection between the kidney or the ureteropelvic junction (UPJ) and the skin. This type of fistula typically manifests as a sinus tract that extends from the kidney or UPJ to the external skin surface. The formation of such fistulous tracts is often attributed to underlying conditions such as kidney stones or infections like tuberculosis. Additionally, they may arise as a result of complications from percutaneous procedures or lithotripsy, which is a treatment that uses shock waves to break up stones in the kidney or ureter. To accurately locate the termination site of the fistulous tract within the abdomen, a radiopaque substance is injected into the fistula. This imaging technique allows for precise identification of the tract's pathway. Once the site is determined, the surgical procedure involves the use of suture ligation to effectively close the open sinus tract. In some cases, additional techniques such as fulguration, which involves the use of heat to destroy tissue, or the injection of fibrin glue, a biological adhesive, may be employed to ensure a secure closure of the fistula. This procedure is critical for preventing further complications and promoting healing in patients with these types of fistulas.