2025 CPT code 52334
(Active) Effective Date: N/A Revision Date: N/A Surgery - Ureter and Pelvis Transurethral Surgical Procedures Surgery Feed
Cystourethroscopy with insertion of a ureteral guidewire through the kidney to establish a percutaneous retrograde nephrostomy.
Modifiers may be appended to 52334 as appropriate to reflect circumstances of the procedure, such as multiple procedures (modifier 51) or bilateral procedures (modifier 50).
Medical necessity for percutaneous nephrostomy is established when less invasive methods of urinary drainage have failed or are contraindicated.Conditions such as obstructing kidney stones, severe hydronephrosis, or severe upper urinary tract infections may necessitate the procedure.Documentation must support the clinical indication for the procedure.
A urologist or other qualified physician specializing in urinary tract procedures would perform this procedure. The physician is responsible for inserting the cystoscope, navigating the guidewire, creating the nephrostomy tract, and securing the nephrostomy tube.
- Surgery
- Surgical Procedures on the Urinary System > Surgical Procedures on the Bladder > Transurethral Surgery Procedures on the Bladder > Ureter and Pelvis Transurethral Surgical Procedures
In simple words: The doctor uses a thin, lighted tube to examine the bladder and urethra.A guidewire is then used to create a small opening from the kidney to the skin to allow urine to drain or for stone removal.
The procedure involves cystourethroscopy, which is the inspection of the interior of the bladder, urethra, prostatic urethra, and ureteric openings using a cystoscope. A guidewire is then inserted through the ureter to create a percutaneous retrograde nephrostomy, an artificial pathway between the kidney and the outside of the body to allow for drainage of urine or stone removal from the renal pelvis.This is done under anesthesia. The cystoscope is inserted into the urethra and advanced into the bladder.Sterile saline is injected to improve visualization. A guidewire is passed through the ureter into a renal calix. A needle is then advanced over the guidewire, exiting through the skin.The tract is dilated, and the guidewire and cystoscope are removed. The nephrostomy tube is secured with sutures.
Example 1: A patient presents with a large kidney stone obstructing the ureter.Cystourethroscopy with percutaneous nephrostomy is performed to establish drainage and relieve obstruction prior to lithotripsy., A patient with severe hydronephrosis (swelling of the kidney due to urine backup) requires urgent decompression.A percutaneous nephrostomy is established via cystourethroscopic guidance to relieve the obstruction and prevent kidney damage., A patient with an upper urinary tract infection refractory to medical management requires drainage of an infected kidney. A percutaneous nephrostomy is placed under cystourethroscopic guidance to facilitate drainage and administration of antibiotics.
Complete history and physical examination, including relevant imaging studies (e.g., KUB, CT scan) demonstrating the need for nephrostomy.Detailed operative report including the approach, type of guidewire and nephrostomy tube used, size of the tract, and amount of drainage obtained.Postoperative imaging (e.g., nephrostogram) to confirm proper placement of the tube.
** The procedure is often performed under fluoroscopic guidance.The type of nephrostomy tube used should be documented.The size of the nephrostomy tract should be documented.Complications such as bleeding, infection, or tube malposition should be documented and appropriately coded.
- Payment Status: Active
- Modifier TC rule: No TC modifier applies.
- Specialties:Urology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center