CPT code 50400 is for a surgical procedure on the renal pelvis, possibly involving the ureter, to correct urinary flow issues.
CPT code 50400 is used to describe a surgical procedure known as a pyeloplasty, specifically the Foley Y-pyeloplasty. This procedure involves a plastic operation on the renal pelvis, which is the area of the kidney where urine collects before moving to the ureter. The code covers a simple version of this operation, which may include additional procedures such as a plastic operation on the ureter, nephropexy (surgical fixation of a kidney), nephrostomy (creating an opening between the kidney and the skin), pyelostomy (creating an opening in the renal pelvis), or ureteral splinting (inserting a device to support the ureter). This code is used by healthcare providers to accurately document and bill for the surgical intervention aimed at correcting obstructions or other issues in the urinary tract that affect kidney function.
For CPT code 50400, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same surgical session.
3. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 62 - Two Surgeons: If two surgeons were required to perform the procedure, this modifier should be used to indicate the collaborative effort.
6. Modifier 66 - Surgical Team: Use this modifier if the procedure required a surgical team due to its complexity.
7. Modifier 76 - Repeat Procedure by Same Physician: Apply this modifier if the same physician performed the procedure more than once on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if a different physician repeated the procedure on the same day.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used when a related procedure is performed during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed during the postoperative period.
11. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was necessary for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Apply this modifier if an assistant surgeon was required due to the unavailability of a qualified resident surgeon.
14. Modifier 99 - Multiple Modifiers: Use this modifier when more than four modifiers are necessary to describe the service provided.
These modifiers should be applied based on the specific details and circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 50400 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, the actual reimbursement for CPT code 50400 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and making coverage determinations within their jurisdiction, so it is essential for healthcare providers to verify the specific reimbursement details and any additional requirements with their respective MAC.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 50400. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
