Description of CPT code 50040

50040 Nephrostomy, nephrotomy with drainage

The physician creates an opening from the kidney to the exterior of the body by making an incision in the kidney. To access the kidney, the physician makes an incision in the skin of the flank, cuts the muscles, fat, and fibrous membranes (fascia) overlying the kidney, and sometimes removes a portion of the eleventh or twelfth rib. Using an incision to open the renal pelvis (pyelotomy), the physician passes a curved clamp into the renal pelvis, a middle or lower minor calyx, and the cortex of the kidney. The physician inserts a catheter tip through the same path as the clamp, and passes the tube through a stab incision in the skin of the flank. After suturing the incisions, the physician inserts a drain tube, bringing it out through a separate stab incision, and performs a layered closure.

Description of CPT code 50432 & 50433

50432 Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation

50433 Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access

The physician inserts a catheter through the skin and into the kidney for drainage of urine and/or for an injection. With the patient lying face down and the puncture site having been identified, a local anesthetic is injected. A needle with a guidewire is slowly advanced into the kidney under fluoroscopic guidance. The needle is removed when urine flows back through and, if necessary, the tract may be dilated to accommodate the catheter or nephrostomy tube, which is advanced over the needle, and the needle is removed. The catheter or nephrostomy tube is fixed in place and secured on the skin with a drainage bag attached. These codes include diagnostic nephrostogram and ureterogram, imaging guidance, and all radiological supervision and interpretation. CPT code 50433 is reported for placement of a nephroureteral catheter via a new access.

Description of CPT code 52334

52334 Cystourethroscopy with insertion of ureteral guide wire through kidney to establish a percutaneous nephrostomy, retrograde

The physician examines the urinary collecting system, and creates an opening through the kidney to the exterior of the body (nephrostomy) by inserting a guidewire through a cystourethroscope. After examining the urinary collecting system through a cystourethroscope inserted through the urethra into the bladder, the physician inserts a catheter through the cystourethroscope into the ureter. The physician passes a guidewire through the ureteral catheter into the kidney and through a small incision in the skin of the flank. The physician removes the cystourethroscope and enlarges (dilates) the percutaneous opening by passing tubes with increasingly larger diameters through the skin incision over the guidewire to the kidney. The physician passes a nephrostomy tube over the guide, removes the guide, and sutures the tube to the skin. The physician usually withdraws the ureteral catheter at the end of the procedure.

Description of CPT code 50436 & 50437

50436 Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed; 

50437  ; including new access into the renal collecting system

A guide is inserted into the renal pelvis and/or ureter to enlarge the passageway between the skin and kidney. The physician makes a small incision in the skin of the back, inserts a large needle, and ultrasonographically guides it toward the kidney. After passing a guidewire through the needle and through the kidney into the renal pelvis, the physician removes the needle by passing it backward over the guidewire. The physician enlarges (dilates) the guidewire passageway by inserting and removing tubes with increasingly larger diameters.

When the passageway is sufficiently dilated, the physician passes a nephrostomy tube over the guidewire, removes the guidewire, and sutures the tube to the skin. All imaging, including radiologic supervision and interpretation, is included and should not be reported separately. CPT code 50436 is reported when the physician enlarges an existing percutaneous nephrostomy tract and inserts a needle into the renal collecting system in order to allow for the introduction of large instruments to be utilized in an endoscopic urologic procedure. CPT code 50437 is reported when the physician creates new access into the renal collecting system in the same operative session where an existing tract is not present.

Description of CPT code 52334

52334 Cystourethroscopy with insertion of ureteral guide wire through kidney to establish a percutaneous nephrostomy, retrograde

The physician examines the urinary collecting system, and creates an opening through the kidney to the exterior of the body (nephrostomy) by inserting a guidewire through a cystourethroscope. After examining the urinary collecting system through a cystourethroscope inserted through the urethra into the bladder, the physician inserts a catheter through the cystourethroscope into the ureter. The physician passes a guidewire through the ureteral catheter into the kidney and through a small incision in the skin of the flank. The physician removes the cystourethroscope and enlarges (dilates) the percutaneous opening by passing tubes with increasingly larger diameters through the skin incision over the guidewire to the kidney. The physician passes a nephrostomy tube over the guide, removes the guide, and sutures the tube to the skin. The physician usually withdraws the ureteral catheter at the end of the procedure.