How To Use CPT Code 50557

CPT 50557 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 50557?

CPT 50557 can be used to describe the procedure of renal endoscopy through an established nephrostomy or pyelostomy. This code is used when the provider examines the kidney, renal pelvis, and ureter, and may perform fulguration and/or incision, with or without biopsy.

2. Official Description

The official description of CPT code 50557 is: ‘Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy.’

3. Procedure

1. The 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 tube is pulled out over the wire.
3. The provider widens the opening passageway using surgical instruments.
4. An endoscope, a small, flexible tube with an attached optical system, is inserted into the kidney through an 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 improve visual perception.
7. Therapeutic solutions may be instilled into the kidney or contrast material may be used for separately reportable radiologic examination of the ureter and renal pelvis.
8. An electrically heated metal cauterizing instrument is introduced through the endoscope to destroy suspected renal tissue or incise the tissue of the renal collecting system.
9. A small piece of kidney tissue may be removed for examination using scissors through the endoscope.
10. Once fulguration, incision, and possibly biopsy are completed, all instruments are withdrawn, tubes are replaced, and the external urinary drainage bag is reconnected for temporary urine flow.

4. Qualifying circumstances

Patients eligible for CPT 50557 are those who require renal endoscopy through an established nephrostomy or pyelostomy. The procedure may involve fulguration and/or incision, with or without biopsy. The provider must use an endoscope to examine the kidney, renal pelvis, and ureter. The patient must have an existing nephrostomy or pyelostomy tract.

5. When to use CPT code 50557

CPT code 50557 should be used when the provider performs renal endoscopy through an established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography. This code should not be used for radiologic services or when the procedure is performed through a different approach.

6. Documentation requirements

To support a claim for CPT 50557, the provider must document the following information:

• Indication for the procedure and the need for renal endoscopy
• Details of the procedure performed, including any irrigation, instillation, or ureteropyelography
• Date and duration of the procedure
• Findings from the examination of the kidney, renal pelvis, and ureter
• Any tissue destruction, incision, or biopsy performed
• Any additional therapeutic measures taken
• Replacement of tubes and reconnection of the external urinary drainage bag
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 50557, ensure that the procedure meets the criteria described in the official description. Do not report CPT 50557 with radiologic services. Review the range of codes from 50551 to 50580 to choose the most appropriate code for the specific case. Consider the documentation requirements and ensure all necessary information is included in the claim.

8. Historical information

CPT 50557 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A provider performs renal endoscopy through an established nephrostomy to examine the renal collecting system and performs fulguration of suspected renal tissue.
2. A patient with an established pyelostomy undergoes renal endoscopy for incision of the renal collecting system and biopsy of kidney tissue.