How To Use CPT Code 50437

CPT 50437 describes the dilation of an existing tract, percutaneous, for an endourologic procedure, including imaging guidance and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed. 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 50437?

CPT 50437 can be used to describe the dilation of an existing tract, percutaneous, for an endourologic procedure. This code includes imaging guidance and all associated radiological supervision and interpretation, as well as postprocedure tube placement if performed. It is used when a provider widens an artificial pathway between the kidney or renal pelvis and the skin, and creates a new tract between the skin and the renal collecting system (renal pelvis).

2. Official Description

The official description of CPT code 50437 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; including new access into the renal collecting system.’

3. Procedure

1. The provider assesses the patient’s condition and determines the need for dilation of an existing percutaneous nephrostomy tract.
2. The provider inserts a series of rigid dilators or a balloon catheter into the existing nephrostomy tract, gradually enlarging it.
3. The provider selects a new site for the creation of a new percutaneous nephrostomy.
4. Under ultrasound or fluoroscopic guidance, the provider inserts a needle through the skin and into the renal collecting system, confirming the placement.
5. The provider injects contrast material to define the renal calices and selects another point above the site to make an incision appropriate for the size of the nephrostomy tube.
6. The provider inserts a needle through the incision into the renal calyx and inserts a guidewire through the needle.
7. The provider inserts dilators of increasing size over the guidewire to sufficiently dilate the tract.
8. The provider inserts a nephrostomy tube over the guidewire to the edge of the collecting system and confirms its position with contrast.
9. The provider may leave a nephrostomy tube in place to keep the tract open for future procedures.

4. Qualifying circumstances

CPT 50437 is performed when there is a need to dilate an existing percutaneous nephrostomy tract and create a new tract into the renal collecting system. It is typically performed for endourologic procedures and requires imaging guidance, such as ultrasound or fluoroscopy. The procedure may involve the placement of a nephrostomy tube to keep the tract open.

5. When to use CPT code 50437

CPT code 50437 should be used when a provider performs the dilation of an existing percutaneous nephrostomy tract and creates a new access into the renal collecting system. It is important to note that this code should not be reported in conjunction with certain other codes, such as 50382, 50384, 50430, 50431, 50432, 50433, 52334, or 74485. It is also not appropriate for nephrolithotomy procedures, which have their own specific codes (50080, 50081).

6. Documentation requirements

To support a claim for CPT 50437, the provider must document the following information:

• Reason for the dilation of the existing percutaneous nephrostomy tract
• Details of the imaging guidance used, such as ultrasound or fluoroscopy
• Date and time of the procedure
• Specific steps taken during the procedure, including the insertion of dilators or a balloon catheter, creation of a new tract, and placement of a nephrostomy tube
• Confirmation of the position of the nephrostomy tube with contrast
• Any additional relevant information or findings

7. Billing guidelines

When billing for CPT 50437, ensure that the procedure meets the criteria outlined in the official description. It is important to note that this code should not be reported with certain other codes, as mentioned earlier. Additionally, consider the specific guidelines provided by payers and coding authorities to ensure accurate and appropriate billing.

8. Historical information

CPT 50437 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A provider dilates an existing percutaneous nephrostomy tract and creates a new access into the renal collecting system for a patient undergoing endourologic stone fragmentation and extraction.
2. A provider performs the dilation of an existing percutaneous nephrostomy tract and creates a new tract for a patient requiring percutaneous drainage of a renal abscess.
3. A provider performs the dilation of an existing percutaneous nephrostomy tract and creates a new access into the renal collecting system for a patient undergoing endourologic laser lithotripsy.
4. A provider dilates an existing percutaneous nephrostomy tract and creates a new tract for a patient requiring percutaneous drainage of a hydronephrotic kidney.
5. A provider performs the dilation of an existing percutaneous nephrostomy tract and creates a new access into the renal collecting system for a patient undergoing endourologic ureteral stent placement.