How To Use CPT Code 50590

CPT 50590 refers to the extracorporeal shock wave lithotripsy procedure used to destroy kidney stones. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 50590.

1. What is CPT 50590?

CPT 50590 is a medical code used to describe the extracorporeal shock wave lithotripsy (ESWL) procedure. ESWL is a non-invasive treatment that uses ultrasound shock waves to break up kidney stones, allowing them to pass easily through the urinary tract. This code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 50590 CPT code description

The official description of CPT code 50590 is: “Lithotripsy, extracorporeal shock wave.”

3. Procedure

The 50590 procedure involves the following steps:

1. The patient is positioned either partially submerged in a tub of water or on a special table with a fluid-filled cushion placed against their body.
2. The physician uses fluoroscopic imaging guidance to locate the kidney stone(s).
3. Ultrasound shock waves are aimed at the stone(s) through the water medium, breaking up the calculus into small fragments.
4. The fragmented stones pass easily through the urinary tract and are eliminated from the body.

4. Qualifying circumstances

Patients eligible to receive CPT code 50590 services are those diagnosed with kidney stones that are causing significant pain, infection, or obstruction. The size, location, and composition of the stone(s) must be considered when determining if ESWL is the appropriate treatment. Additionally, the patient’s overall health, medical history, and any contraindications should be taken into account before proceeding with the procedure.

5. When to use CPT code 50590

It is appropriate to bill the 50590 CPT code when a physician performs the ESWL procedure to treat kidney stones. The procedure should be medically necessary, and the patient must meet the qualifying circumstances mentioned above. The code should not be used for other types of lithotripsy or for procedures that do not involve the use of extracorporeal shock waves.

6. Documentation requirements

To support a claim for CPT 50590, the following information should be documented:

• Patient’s medical history and physical examination findings
• Diagnosis of kidney stones, including size, location, and composition
• Indications for ESWL, such as pain, infection, or obstruction
• Details of the procedure, including patient positioning, imaging guidance, and shock wave delivery
• Outcome of the procedure, including any complications or adverse events
• Follow-up care and instructions provided to the patient

7. Billing guidelines

When billing for CPT code 50590, it is essential to follow the specific guidelines and rules set by the payer. Some tips for billing this code include:

• Ensure that the patient meets the qualifying circumstances for ESWL
• Document all necessary information to support the claim, as mentioned in the documentation requirements section
• Verify the payer’s policies regarding ESWL coverage and any preauthorization requirements
• Use appropriate modifiers, if necessary, to indicate any special circumstances related to the procedure

8. Historical information

CPT 50590 was added to the Current Procedural Terminology system on January 1, 1990. There have been no significant updates to the code since its addition.

9. Similar codes to CPT 50590

Five similar codes to CPT 50590 and how they differ are:

• CPT 50080: This code is used for percutaneous nephrostolithotomy or pyelostolithotomy, which involves the removal of kidney stones through a small incision in the skin.
• CPT 50081: This code is for percutaneous nephrostolithotomy or pyelostolithotomy with the use of a laser, which is a different method of breaking up the stones.
• CPT 50561: This code is for the removal of kidney stones using a ureteroscope, which is inserted through the urethra and bladder to reach the stones.
• CPT 50562: This code is for the removal of kidney stones using a ureteroscope with a laser, which is another method of breaking up the stones.
• CPT 50574: This code is for the removal of kidney stones using a percutaneous nephrostomy, which involves the insertion of a catheter through the skin and into the kidney to remove the stones.

10. Examples

Here are 10 detailed examples of CPT code 50590 procedures:

1. A 45-year-old male with a 10 mm kidney stone causing severe pain undergoes ESWL to break up the stone and facilitate its passage through the urinary tract.
2. A 30-year-old female with recurrent urinary tract infections due to a 7 mm kidney stone undergoes ESWL to eliminate the stone and prevent further infections.
3. A 60-year-old male with a 12 mm kidney stone causing hydronephrosis (swelling of the kidney) undergoes ESWL to relieve the obstruction and restore normal kidney function.
4. A 50-year-old female with a 9 mm kidney stone that has not passed spontaneously after conservative management undergoes ESWL to break up the stone and facilitate its passage.
5. A 40-year-old male with a 6 mm kidney stone causing persistent hematuria (blood in the urine) undergoes ESWL to eliminate the stone and resolve the bleeding.
6. A 55-year-old female with a 15 mm kidney stone causing significant discomfort and reduced quality of life undergoes ESWL to break up the stone and alleviate her symptoms.
7. A 35-year-old male with a 8 mm kidney stone causing intermittent pain and urinary frequency undergoes ESWL to break up the stone and improve his urinary symptoms.
8. A 65-year-old male with a 11 mm kidney stone causing recurrent episodes of renal colic undergoes ESWL to break up the stone and prevent further episodes of pain.
9. A 70-year-old female with a 13 mm kidney stone causing partial obstruction of the urinary tract undergoes ESWL to relieve the obstruction and restore normal urinary flow.
10. A 48-year-old male with a 5 mm kidney stone causing persistent discomfort and impacting his daily activities undergoes ESWL to break up the stone and improve his quality of life.