2025 CPT code 50010
Effective Date: N/A Surgery - Urinary System Surgery Feed
Exploration of kidney; not necessitating other specific procedures
Modifiers may be applicable, such as modifier 50 for bilateral procedures.
Medical necessity is established by the presence of signs, symptoms, or imaging findings suggestive of kidney injury, pathology, or potential complications requiring surgical exploration for diagnosis and/or management.
The surgeon makes an incision, isolates renal vessels, accesses the retroperitoneum, incises Gerota's fascia, drains any hematoma, explores the kidney, washes the wound, may place a drain, and closes the incision in layers.
In simple words: The doctor examines the kidney to look for problems like bleeding, leaks, or injuries. This is done through a surgical incision to directly view the kidney.
Surgical exploration of the kidney for diagnostic purposes, such as to inspect for hemorrhage, urinary leakage, or tissue damage due to trauma, when no other specific procedures are necessary.
Example 1: A patient with blunt abdominal trauma presents with hematuria and suspected kidney injury. A renal exploration (50010) is performed to assess the extent of the damage., A patient experiences persistent flank pain and imaging suggests a possible perirenal hematoma. A renal exploration (50010) is performed to evaluate the hematoma and rule out other pathology., During a previous surgery, there was concern about potential damage to the kidney. A renal exploration (50010) is performed to inspect the kidney and ensure its integrity.
Documentation should include operative report detailing the indication for exploration, findings, and any procedures performed. Pre- and post-operative diagnoses, imaging results, and medical necessity justification should also be included.
- Revenue Code: P1G
- Specialties:Urology, General Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center