2025 CPT code 50225
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Urinary System Surgery Feed
Nephrectomy, including partial ureterectomy, any approach including rib resection; complicated because of previous surgery on the same kidney.
Modifiers may be applicable depending on the circumstances of the procedure (e.g., modifier 51 for multiple procedures if performed during the same surgical session, modifier 22 for increased procedural services if the complexity significantly exceeds the usual).
Medical necessity is established through the presence of a renal mass or condition requiring nephrectomy, potentially complicated by prior surgery on the same kidney.Documentation must support the clinical indication for the surgery (e.g., tumor, infection, trauma) and explain the increased complexity due to the prior surgical history.Justification for the extent of the procedure (including ureterectomy and rib resection) should be clearly stated.
The clinical responsibility lies with the surgeon performing the nephrectomy, including pre-operative planning, intra-operative execution, and post-operative care. This includes assessment, diagnosis, surgical technique selection, and management of potential complications.
In simple words: This code is for removing a kidney (or part of it) and some of the tube that connects the kidney to the bladder.It's used when the surgery is more difficult because the same kidney had surgery before.
This CPT code 50225 describes a nephrectomy (surgical removal of a kidney or part of a kidney) that includes partial ureterectomy (removal of part of the ureter, the tube connecting the kidney to the bladder).The procedure may involve any approach, including rib resection (removal of a rib or ribs) to access the kidney. This code is specifically used when the nephrectomy is complicated by prior surgery on the same kidney. The procedure typically involves making an incision in the abdomen, accessing the kidney, disconnecting the ureter and blood vessels, removing the kidney and a portion of the ureter, and closing the incision.Additional tissues, such as the adrenal gland, may also be removed depending on the specific circumstances.
Example 1: A 60-year-old male patient presents with a large renal tumor and a history of prior kidney surgery for stone removal.A complex nephrectomy with partial ureterectomy is performed, requiring rib resection for optimal access.Code 50225 is appropriate due to the complexity and prior surgery., A 45-year-old female patient undergoes a nephrectomy for a recurrent infection in a kidney previously treated with an unsuccessful pyeloplasty (surgical repair of the renal pelvis).The procedure is coded 50225 given the previous surgery and resultant complexity., A 72-year-old patient needs a nephrectomy due to renal cell carcinoma in a kidney previously biopsied. The surgeon performs a partial nephrectomy, and removes a small portion of the ureter, necessitating rib resection for access. 50225 accurately reflects the surgical complexity arising from the previous biopsy.
Detailed operative report specifying the approach (open vs. laparoscopic), extent of nephrectomy (partial vs. total), presence of partial ureterectomy, rib resection, prior surgical history on the same kidney, and any other associated procedures or complications.Pre-operative imaging (e.g., CT scan, MRI) confirming tumor location and size, pathology report confirming diagnosis, and post-operative progress notes are also needed.
** Consider using appropriate modifiers to reflect the complexity of the procedure and any additional services performed.Always consult the most recent CPT manual and payer guidelines for accurate coding and reimbursement.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Specialties:Urology, General Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center