How To Use CPT Code 50436

CPT 50436 describes the dilation of an existing percutaneous nephrostomy tract, with the use of imaging guidance and postprocedure tube placement. 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 50436?

CPT 50436 can be used to describe the dilation of an existing percutaneous nephrostomy tract. This procedure involves widening the artificial pathway between the kidney or renal pelvis and the skin. The provider may also place a tube in the tract after dilation to keep it open. The code includes imaging guidance, such as ultrasound or fluoroscopy, and all associated radiological supervision and interpretation.

2. Official Description

The official description of CPT code 50436 is: ‘Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed.’

3. Procedure

1. The provider begins by appropriately prepping the patient and anesthetizing the area with a 1% lidocaine solution.
2. Using imaging guidance, such as ultrasound or fluoroscopy, the provider inserts a series of rigid dilators or a balloon catheter into the nephrostomy tract.
3. The dilators or balloon catheter are gradually expanded, stretching and enlarging the tract.
4. If necessary, the provider may leave a nephrostomy tube in place to keep the tract open and prepare for future procedures, such as kidney stone fragmentation and extraction.

4. Qualifying circumstances

CPT 50436 is performed on patients who already have an existing percutaneous nephrostomy tract that requires dilation. This procedure is typically done when there is a need to widen the tract for better access or to accommodate larger instruments. The provider may use imaging guidance, such as ultrasound or fluoroscopy, during the procedure. The code also covers radiological supervision and interpretation.

5. When to use CPT code 50436

CPT code 50436 should be used when a provider performs the dilation of an existing percutaneous nephrostomy tract, with the use of imaging guidance and postprocedure tube placement. This code should not be used for the creation of a new nephrostomy tract.

6. Documentation requirements

To support a claim for CPT 50436, the provider must document the following information:

• Indication for the dilation of the existing nephrostomy tract
• Details of the procedure, including the use of imaging guidance and the specific dilators or balloon catheter used
• Date of the procedure and the start and end times
• Any complications or adverse events that occurred during the procedure
• Placement of a postprocedure tube, if performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 50436, ensure that the procedure meets the criteria described in the official description. The use of imaging guidance and postprocedure tube placement must be documented. It is important to note that CPT code 50436 should not be reported with CPT codes 50437 or any other codes for the creation of a new nephrostomy tract.

8. Historical information

CPT 50436 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates or changes to the code since its addition.

9. Examples

1. A urologist performs the dilation of an existing percutaneous nephrostomy tract for a patient with kidney stones, using fluoroscopy guidance and placing a postprocedure tube.
2. An interventional radiologist uses ultrasound guidance to dilate an existing percutaneous nephrostomy tract in a patient with a urinary obstruction, without the need for postprocedure tube placement.
3. A nephrologist performs the dilation of an existing percutaneous nephrostomy tract for a patient with a recurrent urinary tract infection, using both ultrasound and fluoroscopy guidance and placing a postprocedure tube.
4. A radiologist performs the dilation of an existing percutaneous nephrostomy tract for a patient with a renal tumor, using fluoroscopy guidance and placing a postprocedure tube.
5. An interventional radiologist uses ultrasound guidance to dilate an existing percutaneous nephrostomy tract in a patient with hydronephrosis, without the need for postprocedure tube placement.
6. A urologist performs the dilation of an existing percutaneous nephrostomy tract for a patient with a ureteral stricture, using both ultrasound and fluoroscopy guidance and placing a postprocedure tube.
7. An interventional radiologist uses fluoroscopy guidance to dilate an existing percutaneous nephrostomy tract in a patient with a renal cyst, without the need for postprocedure tube placement.
8. A nephrologist performs the dilation of an existing percutaneous nephrostomy tract for a patient with polycystic kidney disease, using ultrasound guidance and placing a postprocedure tube.
9. A radiologist performs the dilation of an existing percutaneous nephrostomy tract for a patient with a renal abscess, using fluoroscopy guidance and placing a postprocedure tube.
10. An interventional radiologist uses both ultrasound and fluoroscopy guidance to dilate an existing percutaneous nephrostomy tract in a patient with a ureteral stone, without the need for postprocedure tube placement.