How To Use CPT Code 50065

CPT 50065 describes a secondary surgical operation for calculus, specifically nephrolithotomy. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 50065?

CPT 50065 is used to describe a secondary surgical procedure known as nephrolithotomy. This procedure is performed when a previous nephrolithotomy was not entirely successful in removing all of the calculus deposits, which are kidney stones formed by the accumulation of mineral salts or other materials in the kidney. The purpose of this procedure is to remove the remaining stones and ensure the patient’s kidney health.

2. Official Description

The official description of CPT code 50065 is: ‘Nephrolithotomy; secondary surgical operation for calculus.’

3. Procedure

1. The patient is positioned in a prone position, and the surgical site is prepared with an antiseptic liquid called Betadine.
2. An incision is made into the back, specifically on the side overlying the affected kidney.
3. A tunnel is created directly into the kidney through the skin.
4. A nephroscope, equipped with a light source, is inserted into the kidney through the tunnel to visualize the inside of the kidney.
5. The physician removes smaller stones directly using a device with a basket at the end.
6. Larger stones are fragmented into smaller pieces using ultrasound for easier removal.
7. A nephrostomy tube is placed to allow drainage of fluid from the kidney into a bag.
8. After the stones are completely removed, the incision site is sutured.

4. Qualifying circumstances

CPT 50065 is performed as a secondary procedure when a previous nephrolithotomy was not entirely successful in removing all of the calculus deposits. The patient must have calculus, which refers to the accumulation of mineral salts or other materials in the kidney, forming a stone. This procedure is typically performed by a physician and requires the use of a nephroscope and ultrasound for stone removal.

5. When to use CPT code 50065

CPT code 50065 should be used when a secondary surgical operation for calculus, specifically nephrolithotomy, is performed. It is important to note that this code is only applicable when a previous nephrolithotomy was not entirely successful in removing all of the calculus deposits. If the initial procedure successfully removed all of the stones, CPT code 50065 should not be used.

6. Documentation requirements

To support a claim for CPT 50065, the following documentation should be included:

• Documentation indicating that a previous nephrolithotomy was performed and was not entirely successful in removing all of the calculus deposits
• Description of the surgical procedure performed, including details of the incision, use of a nephroscope and ultrasound, stone removal techniques, and placement of a nephrostomy tube
• Date of the procedure
• Any complications or additional procedures performed during the surgery
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 50065, ensure that the procedure meets the criteria for a secondary surgical operation for calculus. It is important to document the previous nephrolithotomy and the need for the secondary procedure. CPT code 50065 should not be reported if the initial procedure successfully removed all of the calculus deposits. Additionally, consider using modifier 22 if the procedure is complicated by a congenital kidney abnormality.

8. Historical information

CPT 50065 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. However, it is worth noting that Medicare added CPT 50065 to the Inpatient Only (IPO) list in 2017, indicating that it is typically performed in an inpatient setting.

9. Examples

1. A patient undergoes a nephrolithotomy to remove kidney stones, but some stones remain. A secondary surgical operation (CPT 50065) is performed to remove the remaining stones.
2. After an initial nephrolithotomy, a patient experiences persistent symptoms and imaging reveals the presence of residual calculus. The physician performs a secondary surgical operation (CPT 50065) to remove the remaining stones.
3. Following an unsuccessful initial nephrolithotomy, a patient requires a secondary surgical operation (CPT 50065) to address the remaining calculus deposits in the kidney.
4. A patient undergoes a nephrolithotomy, but imaging shows the presence of residual stones. The physician performs a secondary surgical operation (CPT 50065) to remove the remaining calculus.
5. After an unsuccessful initial attempt to remove kidney stones through nephrolithotomy, a patient undergoes a secondary surgical operation (CPT 50065) to address the remaining calculus deposits.
6. Following an incomplete removal of kidney stones during an initial nephrolithotomy, a patient requires a secondary surgical operation (CPT 50065) to remove the remaining calculus.
7. A patient undergoes a nephrolithotomy, but some stones are not successfully removed. A secondary surgical operation (CPT 50065) is performed to address the remaining calculus deposits.
8. After an unsuccessful initial nephrolithotomy, a patient requires a secondary surgical operation (CPT 50065) to remove the remaining kidney stones.
9. Following an incomplete removal of kidney stones during an initial nephrolithotomy, a patient undergoes a secondary surgical operation (CPT 50065) to address the remaining calculus deposits.