How To Use CPT Code 50433

CPT 50433 describes the percutaneous placement of a nephroureteral catheter, including diagnostic imaging 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 50433?

CPT 50433 can be used to describe the percutaneous placement of a nephroureteral catheter, which involves inserting a catheter through the skin into the kidney to divert urine in cases of blockage within the renal pelvis or ureters. This procedure may also include the injection of contrast material to visualize the internal structures of the kidney and ureter. The code encompasses the creation of a new access route into the kidney and all radiological supervision and interpretation.

2. Official Description

The official description of CPT code 50433 is: ‘Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access.’

3. Procedure

1. The provider prepares the patient and uses imaging guidance, such as ultrasound or fluoroscopy, to locate the renal pelvis and ureter.
2. A small incision is made in the skin, and a needle introducer is inserted through the incision and into the ureter and renal pelvis.
3. A guide wire is then passed through the needle, and a nephroureteral catheter is advanced over the wire into the kidneys.
4. The guide wire is removed, and the provider ensures the correct positioning of the catheter.
5. The catheter is attached to an external drainage system, and a bandage is applied to the stoma.
6. If necessary, contrast material may be injected through the catheter to enhance visualization of the renal pelvis and/or ureters, and images are obtained for later review.

4. Qualifying circumstances

CPT 50433 is performed on patients who require the diversion of urine due to blockage within the renal pelvis or ureters. It is important to note that this code should not be reported in conjunction with other codes that involve the same renal collecting system and/or associated ureter. Additionally, it should not be reported for the dilation of the nephroureteral catheter tract. For the removal and replacement of a nephroureteral catheter, a different code, 50387, should be used.

5. When to use CPT code 50433

CPT code 50433 should be used when a provider performs the percutaneous placement of a nephroureteral catheter, including diagnostic imaging and all associated radiological supervision and interpretation. It is important to ensure that the procedure involves the creation of a new access route into the kidney. If the provider is converting a nephrostomy catheter to a nephroureteral catheter via an existing access route, a different code, 50434, should be used. Similarly, for the simple placement of a nephrostomy catheter, code 50432 should be used. If the provider is exchanging a nephrostomy catheter, code 50435 should be used.

6. Documentation requirements

To support a claim for CPT 50433, the provider must document the following information:

• Patient’s diagnosis and the need for the placement of a nephroureteral catheter
• Specific imaging guidance used, such as ultrasound or fluoroscopy
• Date of the procedure and the start and end times
• Details of the procedure, including the creation of a new access route and the placement of the catheter
• Any contrast material injected and images obtained
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 50433, it is important to ensure that the procedure meets the criteria outlined in the official description. The code should not be reported in conjunction with other codes that involve the same renal collecting system and/or associated ureter. Additionally, the code should not be reported for the dilation of the nephroureteral catheter tract. It is important to review CPT and payer-specific guidelines for any additional requirements or considerations.

8. Historical information

CPT 50433 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 percutaneous placement of a nephroureteral catheter, including diagnostic imaging and all associated radiological supervision and interpretation.
2. A provider uses ultrasound guidance to place a nephroureteral catheter in a patient with a ureteral obstruction, ensuring proper drainage of urine.
3. Using fluoroscopy, a provider performs the percutaneous placement of a nephroureteral catheter in a patient with a renal pelvis blockage, injecting contrast material to visualize the internal structures of the kidney and ureter.
4. A patient with a ureteral stricture undergoes the percutaneous placement of a nephroureteral catheter, allowing for the diversion of urine and relieving the obstruction.
5. Using imaging guidance, a provider places a nephroureteral catheter in a patient with a ureteral stone, facilitating the passage of urine and aiding in the management of the condition.