How To Use CPT Code 50290

CPT 50290 describes the excision of a perinephric cyst, which involves the removal of a cyst from the tissue surrounding the kidney. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 50290?

CPT 50290 can be used to describe the excision of a perinephric cyst, which is a collection of fluid around the kidney. The procedure involves making an incision in the skin over the affected kidney, dissecting the perirenal muscles and fat, and removing the cyst wall. The provider may also retrieve tissue samples for further examination and use fulguration to destroy any remaining cyst wall attached to the renal connective tissue. The incision is then closed, and a drain tube may be inserted for temporary drainage.

2. Official Description

The official description of CPT code 50290 is: ‘Excision of perinephric cyst.’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. An incision is made in the skin over the affected kidney.
3. The perirenal muscles are cut, and the perirenal fat and Gerota’s fascia are dissected to reach the cyst.
4. The perinephric fat around the cyst is dissected to expose the entire cyst.
5. The cyst wall is excised, and tissue samples may be retrieved for histopathologic examination.
6. Fulguration may be used to destroy any remaining cyst wall attached to the renal connective tissue.
7. Sutures may be used for repair if necessary.
8. A drain tube may be inserted for temporary drainage.
9. Bleeding is controlled, and the incision is closed.

4. Qualifying circumstances

CPT 50290 is performed when there is a perinephric cyst, which is a collection of fluid around the kidney. The procedure is typically done when the cyst causes symptoms or complications, such as pain, infection, or obstruction. The provider must assess the patient’s condition and determine the need for excision of the cyst.

5. When to use CPT code 50290

CPT code 50290 should be used when the provider performs an excision of a perinephric cyst. It is important to ensure that the procedure is medically necessary and meets the criteria for reimbursement. The code should not be used for other types of cysts or procedures performed on different areas of the kidney.

6. Documentation requirements

To support a claim for CPT 50290, the provider must document the following information:

• Patient’s diagnosis of a perinephric cyst
• Description of the procedure performed, including the incision, dissection, excision, and any additional techniques used
• Date of the procedure
• Any tissue samples retrieved for histopathologic examination
• Use of fulguration or sutures, if applicable
• Insertion of a drain tube, if performed
• Control of bleeding and closure of the incision

7. Billing guidelines

When billing for CPT 50290, ensure that the procedure performed is an excision of a perinephric cyst. It is important to follow the specific guidelines and requirements of the payer, including any modifiers or additional documentation that may be necessary for reimbursement. CPT code 50290 should not be reported with other codes unless there are separate and distinct procedures performed during the same operative session.

8. Historical information

CPT code 50290 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement.

9. Examples

1. A urologist performs an excision of a perinephric cyst for a patient experiencing severe pain and recurrent infections.
2. A nephrologist excises a perinephric cyst and retrieves tissue samples for histopathologic examination to rule out malignancy.
3. A general surgeon performs an excision of a perinephric cyst and uses fulguration to destroy any remaining cyst wall attached to the renal connective tissue.
4. An interventional radiologist performs an excision of a perinephric cyst and inserts a drain tube for temporary drainage.
5. A urologic oncologist excises a perinephric cyst during a partial nephrectomy procedure for a patient with a complex renal mass.
6. A pediatric urologist performs an excision of a perinephric cyst in a child with a congenital kidney abnormality.
7. A transplant surgeon excises a perinephric cyst during a total nephrectomy procedure for a deceased donor kidney transplant.
8. An interventional radiologist performs an excision of a perinephric cyst and uses sutures for repair due to the size and location of the cyst.
9. A urologist excises a perinephric cyst and controls bleeding during the procedure using hemostatic agents.
10. A general surgeon performs an excision of a perinephric cyst and closes the incision using a layered closure technique.