How To Use CPT Code 50551

CPT 50551 describes the procedure of renal endoscopy through an established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 50551?

CPT 50551 can be used to describe the procedure of renal endoscopy through a previously established opening between the kidney and the exterior of the body or a previously established opening between the renal pelvis and the exterior of the body. During this procedure, a healthcare provider inserts an endoscope into the kidney through the established nephrostomy or pyelostomy tract to examine the kidney, renal pelvis, and ureter.

2. Official Description

The official description of CPT code 50551 is: ‘Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service.’

3. Procedure

1. The healthcare provider disconnects the external urinary drainage bag from the nephrostomy or pyelostomy tube.
2. A guidewire is moved forward through the nephrostomy tube, and the nephrostomy tube is pulled out over the wire.
3. The provider may use surgical instruments to widen the opening passageway.
4. An endoscope, a small, flexible tube with an attached optical system, is inserted into the kidney through the established nephrostomy or pyelostomy tract.
5. The provider uses the endoscope to analyze the interior structures of the renal collecting system.
6. Sterile saline solution may be added to the area of the renal collecting system for better visual perception.
7. The provider may instill therapeutic solutions into the kidney or use contrast material for separately reportable radiologic examination of the ureter and renal pelvis.
8. Once the examination is completed, the provider withdraws all the instruments, replaces the tubes, and reconnects the external urinary drainage bag to the tubes for temporary urine flow.

4. Qualifying circumstances

CPT 50551 is performed on patients who require renal endoscopy through an established nephrostomy or pyelostomy. This procedure is exclusive of radiologic service and may involve irrigation, instillation, or ureteropyelography. The patient must have a previously established opening between the collecting system of the kidney and the exterior of the body or a previously established opening between the renal pelvis and the exterior of the body.

5. When to use CPT code 50551

CPT code 50551 should be used when a healthcare provider performs renal endoscopy through an established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography. This code should not be used if radiologic services are included in the procedure.

6. Documentation requirements

To support a claim for CPT 50551, the healthcare provider must document the following information:

• Details of the procedure performed, including whether irrigation, instillation, or ureteropyelography was involved
• Date of the procedure
• Specific findings or observations during the endoscopy
• Any additional procedures or interventions performed during the same session
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 50551, ensure that the procedure meets the criteria described in the official description. This code should not be reported with other codes that include radiologic services. Review the range of endoscopy procedures on the kidney (50551-50580) to choose the most appropriate code for the specific procedure performed.

8. Historical information

CPT 50551 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone a code change on January 1, 2010, with an updated description.

9. Examples

1. A healthcare provider performs renal endoscopy through an established nephrostomy to examine the renal collecting system and identifies a renal stone that requires removal.
2. During a procedure, a healthcare provider performs renal endoscopy through an established pyelostomy and dilates a ureteral stricture.
3. A patient with a nephrostomy tube undergoes renal endoscopy to examine the renal pelvis and ureter, and a foreign body is discovered and removed.
4. A healthcare provider performs renal endoscopy through an established nephrostomy and performs fulguration of a renal pelvic tumor.
5. During a procedure, a healthcare provider removes a nephrostomy tube and a renal stone through an established pyelostomy.
6. A patient with a nephrostomy tube undergoes renal endoscopy to examine the renal collecting system and ureter, and a biopsy of a suspicious lesion is performed.