2025 CPT code 50387
Effective Date: N/A Surgery - Surgical Procedures on the Urinary System Feed
Removal and replacement of externally accessible nephroureteral catheter (e.g., external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation.
Modifiers such as 22 (Increased Procedural Services), 50 (Bilateral Procedure), 52 (Reduced Services), 53 (Discontinued Procedure), 73 (Discontinued Outpatient Hospital/ASC Procedure Prior to Anesthesia), 74 (Discontinued Outpatient Hospital/ASC Procedure After Anesthesia), and others may be applicable depending on the specific circumstances.
Medical necessity for this procedure is established by the presence of a condition requiring drainage of the kidney, such as obstruction, stricture, or leak. The documentation must clearly support the need for the stent exchange.
The physician is responsible for the entire procedure, including prepping, anesthesia, insertion, and confirmation of the new stent placement and functionality using fluoroscopy.
In simple words: The doctor uses real-time x-ray imaging to replace a tube that drains urine from the kidney. This tube goes from the kidney to the bladder and exits through the skin. The procedure involves inserting a wire to guide the new tube into place, removing the old one, and checking the new tube's position with a special dye.
This procedure involves removing and replacing an externally accessible nephroureteral stent/catheter using fluoroscopic guidance (live, real-time X-ray imaging).A nephroureteral catheter connects the ureter and renal pelvis (the collecting system of the kidney) to an external drainage system. The procedure includes radiological supervision and interpretation.The provider infiltrates the skin and subcutaneous tissues at the catheter entry site. Contrast may be injected into the catheter to visualize the site and assist with the new stent placement. The suture to the kidney is incised, and a guidewire is placed through the hub of the stent and into the bladder, using fluoroscopy to guide it. The existing catheter is removed over the guidewire, and the new nephroureteral stent is passed over the guidewire into the bladder. The guidewire is partially removed to allow formation of the distal loop within the bladder. After proper positioning, the guidewire is fully removed, the suture is positioned, and contrast is injected to confirm placement and function. Final adjustments are made, the catheter site is dressed, and a drainage bag may be attached.Images of the final catheter position are obtained.
Example 1: A patient with a blocked ureter due to a kidney stone has a nephroureteral stent placed to allow urine drainage.The stent needs to be exchanged due to encrustation or blockage. , A patient undergoing cancer treatment requires periodic replacement of their nephroureteral stent to maintain urine flow and prevent complications., A patient with a ureteral injury needs a nephroureteral stent placed temporarily.After healing, the existing stent is exchanged for a new one before final removal.
Documentation should include the medical necessity for the procedure (e.g., blockage, stricture, injury), details of the procedure including fluoroscopic guidance, type of stent used, any complications encountered, and confirmation of proper placement and function.The operative report should also include details regarding radiological supervision and interpretation.
- Specialties:Urology, Interventional Radiology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Inpatient Hospital