2025 CPT code 50070

Nephrolithotomy; complicated by congenital kidney abnormality

Adhere to the current CPT coding guidelines for surgical procedures of the urinary system. Pay close attention to the description of the procedure and any associated complications to ensure appropriate code selection. Note that the presence of a congenital anomaly modifies the complexity of the procedure and may influence the choice of code.

Modifiers such as 50 (bilateral procedure), 51 (multiple procedures), and others might be applicable depending on the circumstances. Refer to the CPT manual and payer guidelines for appropriate modifier usage.

Medical necessity for 50070 is established by the presence of symptomatic kidney stones causing significant pain or other complications (such as infection or obstruction), confirmed by imaging studies, and the need for surgical intervention due to the complexity introduced by the associated congenital kidney anomaly.Failure of less invasive methods like shock wave lithotripsy (SWL) may also warrant surgical intervention.

The clinical responsibility for this procedure rests with a surgeon specializing in urology.The surgeon will be responsible for all aspects of the surgery including pre-operative planning, intra-operative technique, and post-operative care.Anesthesiologists, nurses, and other support staff will also play a role.

IMPORTANT Depending on the specifics of the case and the size/location of the stones, alternative codes such as 50080, 50081 (for percutaneous approaches) or other open surgical codes might be more appropriate.Consult the CPT manual for detailed guidance on code selection.

In simple words: The doctor cuts into the kidney to remove kidney stones.This is a more difficult surgery because the kidney has a birth defect, making the procedure more complex.

This CPT code describes a nephrolithotomy procedure complicated by a congenital kidney abnormality.The procedure involves an incision into the kidney to remove kidney stones, but the complexity is increased due to the presence of a birth defect affecting the kidney's structure or function. This may necessitate more extensive dissection, manipulation, and potentially specialized techniques to safely remove the stones.

Example 1: A 30-year-old male patient presents with a history of severe flank pain and hematuria. Imaging reveals multiple stones in a horseshoe kidney (congenital anomaly). A nephrolithotomy is performed to remove the stones. Code 50070 is applied due to the congenital anomaly., A 25-year-old female with a history of duplicated collecting system (congenital anomaly) is diagnosed with kidney stones in one of the collecting systems.A nephrolithotomy is required for stone removal, necessitating careful surgical approach because of the abnormal anatomy. Code 50070 would accurately reflect this scenario., An infant with a diagnosed renal agenesis (congenital absence of one kidney) is found to have a large kidney stone in the single functioning kidney. A nephrolithotomy is performed to remove the stone; due to the presence of congenital renal anomaly, 50070 would apply.

Complete operative report detailing the surgical approach, description of the congenital abnormality, number and size of stones removed, intraoperative findings, complications (if any), and post-operative course.Pre-operative imaging studies demonstrating the kidney stones and the congenital anomaly.Pathology report confirming the nature of the removed stones.Anesthesia record.

** Accurate coding requires a thorough review of the operative report and supporting documentation to ensure the presence and nature of the congenital kidney abnormality and its influence on the complexity of the nephrolithotomy.If the congenital anomaly significantly alters the surgical approach, this should be clearly documented.

  • Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
  • RVU: This information is not available in the provided text.Consult the current CPT codebook or a relevant fee schedule for RVU values.
  • Global Days : The global period for this procedure would vary depending on payer and local standards; additional information is required to ascertain the specific global days.
  • Payment Status: Active
  • Modifier TC rule: The applicability of a TC (Technical Component) modifier is dependent on specific circumstances. This requires referencing the specific documentation.
  • Fee Schedule : Fee schedule data is not provided in the given sources and varies by payer and location. Consult a fee schedule database for this information.
  • Specialties:Urology
  • Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Outpatient Hospital
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