How To Use CPT Code 50431

CPT 50431 describes the injection procedure for antegrade nephrostogram and/or ureterogram, which is a complete diagnostic procedure including imaging guidance and all associated radiological supervision and interpretation. 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 50431?

CPT 50431 is used to describe the injection procedure for antegrade nephrostogram and/or ureterogram. This procedure involves the use of imaging guidance, such as ultrasound or fluoroscopy, to inject contrast material into the ureters or kidney. The purpose of this procedure is to analyze the internal structures of the kidneys, renal pelvis, and/or ureters. It is typically performed to assess nephrostomy or pyelostomy tube function, identify blockage in the ureteropelvic junction, or check for urine leakage around the tube insertion site.

2. Official Description

The official description of CPT code 50431 is: ‘Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access.’

3. Procedure

1. The provider prepares the patient and ensures they are appropriately prepped and anesthetized.
2. Using imaging guidance, such as ultrasound or fluoroscopy, the provider inserts a catheter through an existing access route into the ureters or renal pelvis.
3. The provider injects contrast material through the catheter into the areas they want to image.
4. Images of the kidney, renal pelvis, and/or ureter are taken, and the provider interprets the images to analyze the internal structures.

4. Qualifying circumstances

CPT 50431 is performed when there is an existing access route for the injection procedure. It is used to assess the internal structures of the kidneys, renal pelvis, and/or ureters using imaging guidance. The procedure may be performed to evaluate nephrostomy or pyelostomy tube function, identify blockage in the ureteropelvic junction, or check for urine leakage around the tube insertion site.

5. When to use CPT code 50431

CPT code 50431 should be used when the provider performs the complete diagnostic procedure of injecting contrast material into the ureters or kidney using imaging guidance and all associated radiological supervision and interpretation. This code is specifically for cases where there is an existing access route for the procedure. If a new access route is used, CPT code 50430 should be reported instead.

6. Documentation requirements

To support a claim for CPT 50431, the provider must document the following information:

• Reason for the procedure and the need for diagnostic evaluation
• Details of the imaging guidance used, such as ultrasound or fluoroscopy
• Date and time of the procedure
• Specific areas injected with contrast material
• Images taken and the provider’s interpretation of the images
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 50431, ensure that the procedure is performed using an existing access route. Do not report CPT 50431 in conjunction with codes 50432, 50433, 50434, 50435, 50693, 50694, 50695, or 74425 for the same renal collecting system and/or associated ureter. This code includes all associated radiological supervision and interpretation, so separate coding for radiology services is not necessary. Review CPT and payer-specific guidelines for any additional requirements or considerations.

8. Historical information

CPT 50431 was added to the Current Procedural Terminology system on January 1, 2016. There have been no updates to the code since its addition.

9. Examples

1. A patient with a nephrostomy tube undergoes an injection procedure for antegrade nephrostogram to assess the function of the tube and identify any blockage in the ureteropelvic junction.
2. A patient with a pyelostomy tube receives an injection procedure for antegrade ureterogram to evaluate the tube’s function and check for urine leakage around the tube insertion site.
3. A patient with a history of kidney stones undergoes an injection procedure for antegrade nephrostogram to analyze the internal structures of the kidneys and renal pelvis.
4. A patient with a suspected ureteral obstruction undergoes an injection procedure for antegrade ureterogram to identify the location and extent of the blockage.
5. A patient with a history of urinary tract infections undergoes an injection procedure for antegrade nephrostogram to assess the condition of the kidneys and ureters.
6. A patient with a history of urinary incontinence undergoes an injection procedure for antegrade ureterogram to evaluate the function of the ureters and identify any abnormalities.
7. A patient with a history of kidney trauma undergoes an injection procedure for antegrade nephrostogram to assess the internal structures of the kidneys and identify any injuries.