How To Use CPT Code 50432

CPT 50432 describes the placement of a nephrostomy catheter using imaging guidance, such as ultrasound or fluoroscopy, to divert urine due to blockage within the renal pelvis or ureters. 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 50432?

CPT 50432 can be used to describe the percutaneous placement of a nephrostomy catheter by a healthcare provider. This procedure involves inserting a catheter through the skin into the renal pelvis to divert urine in cases where there is a blockage within the renal pelvis or ureters. The placement of the catheter is guided by imaging technologies such as ultrasound or fluoroscopy. The procedure also includes the injection of contrast material to visualize the internal structures of the kidney and ureter.

2. Official Description

The official description of CPT code 50432 is: ‘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.’

3. Procedure

1. The healthcare provider prepares the patient for the procedure, ensuring appropriate anesthesia and prepping the area.
2. Using imaging guidance, such as ultrasound or fluoroscopy, the provider makes a small incision in the skin and inserts a needle introducer into the kidney and/or ureter.
3. A guide wire is then inserted through the needle, and a nephrostomy catheter is advanced over the wire into the kidneys.
4. The guide wire is withdrawn, and contrast material may be injected through the catheter to enhance visualization of the renal pelvis and/or ureters.
5. The provider ensures the correct positioning of the catheter and attaches it to an external drainage system.
6. A bandage is placed around the stoma, or opening, created by the catheter.

4. Qualifying circumstances

CPT 50432 is used for patients who require the placement of a nephrostomy catheter due to blockage within the renal pelvis or ureters. The procedure is performed by a healthcare provider using imaging guidance, such as ultrasound or fluoroscopy. It is important to note that CPT 50432 should not be reported in conjunction with other codes that involve the same renal collecting system and/or associated ureter, or for the dilation of the nephrostomy tube tract.

5. When to use CPT code 50432

CPT code 50432 should be used when a healthcare provider performs the percutaneous placement of a nephrostomy catheter using imaging guidance, such as ultrasound or fluoroscopy. This code should not be used for other procedures involving the renal collecting system and/or associated ureter, or for the dilation of the nephrostomy tube tract.

6. Documentation requirements

To support a claim for CPT 50432, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the placement of a nephrostomy catheter
• Details of the imaging guidance used, such as ultrasound or fluoroscopy
• Date of the procedure
• Start and end time of the procedure
• Injection of contrast material, if performed
• Confirmation of correct positioning of the catheter
• Attachment of the catheter to an external drainage system
• Placement of a bandage around the stoma
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 50432, ensure that the procedure is performed by a healthcare provider using imaging guidance, such as ultrasound or fluoroscopy. It is important to follow CPT and payer-specific guidelines to determine if additional radiology services should be separately coded. CPT 50432 should not be reported in conjunction with other codes involving the same renal collecting system and/or associated ureter, or for the dilation of the nephrostomy tube tract.

8. Historical information

CPT 50432 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 blockage in the renal pelvis undergoes the percutaneous placement of a nephrostomy catheter using ultrasound guidance.