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    v1.0.30
    OpenPayerBilling CodesIncision Procedures on the KidneyCPT cpt-50040-creation-of-renal-cutaneous-fistula-nephrostomy
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    CPT 50040: Open Nephrostomy for Urinary Obstruction

    Medicare pays $848 on average nationally for this procedure.

    CPT code 50040 describes an open surgical procedure to create a direct opening from the kidney to the outside of the abdomen (nephrostomy) when obstruction prevents urine drainage; this service is a surgical decompression of the renal collecting system typically performed in an operating room or procedural suite and classified as inpatient or outpatient surgical care depending on clinical status and need for postoperative monitoring.

    For related coverage guidance, see recent payer policy updates: Surgical Procedures, Outpatient Surgical Procedures - Site of Service, Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 62-year-old female presenting with flank pain, fever, and rising serum creatinine after known bilateral ureteral obstruction from advanced ovarian carcinoma. Imaging (CT abdomen/pelvis) demonstrates hydronephrosis with purulent material in the collecting system consistent with pyonephrosis and an obstructing pelvic mass. The urology team is consulted for urgent decompression of the renal collecting system. After preoperative optimization, the patient is taken to the operating room for an open nephrostomy/pyelostomy through a flank/abdominal approach to create a direct external drainage tract from the renal pelvis to the skin under general anesthesia. The procedure relieves obstruction, allows drainage of infected urine, provides access for antegrade stent placement if needed, and permits culture-directed antibiotic therapy.

    The clinical workflow includes preoperative imaging review and consent, perioperative antibiotics, general anesthesia with appropriate monitoring, surgical incision and exposure of the kidney, creation of a renal pelvis opening with placement of an external nephrostomy tube, securing the tube and wound closure, and postoperative monitoring for bleeding, urine output, and resolution of sepsis. Documentation should include indication (e.g., obstructive uropathy with pyonephrosis), laterality, technique, any intraoperative findings (pus, stones, tumor invasion), estimated blood loss, complications, and the exact device placed (size/type of nephrostomy tube).

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    50392Placement of nephrostomy tube, percutaneous, including imaging guidance when performedAlternative, image-guided percutaneous approach to renal decompression often performed by interventional radiology instead of open surgical nephrostomy.
    50590Extracorporeal shock wave lithotripsy (ESWL), bilateral or unilateral; percutaneous nephrolithotomy; or other stone removal procedures (note: 50590 is commonly used for percutaneous nephrolithotomy)Performed when obstructing renal calculi are the cause of obstruction; may be staged before or after external drainage.
    51000Aspiration of renal cyst (percutaneous)Diagnostic or decompressive procedure for renal cysts; distinct but may be part of differential interventions.
    52000Cystoscopy, diagnostic, with or without collection of urine specimenMay be performed pre- or post-procedure for evaluation of lower tract etiology or for retrograde stent placement.
    55866Insertion of suprapubic tube [note: urologic drainage]Alternative urinary diversion for some patients; considered in broader urinary diversion workflows.

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208800000X
    363L00000X
    207RH0000X
    207P00000X
    246QL0901X
    332S00000X
    332B00000X
    207QB0002X

    Related Payer Policy Updates

    Specialty: General Surgery1 / 2

    10 rows

    PolicyPayerEffective Date
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01
    Medical Necessity Guidelines — Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Ambulatory Surgery Center (ASC) - Site of Care PolicyKaiser Permanente2026-08-01

    Related Codes

    CPT-50010-RENAL-DIAGNOSTIC-EXPLORATION-KIDNEY

    CPT 50010: Diagnostic Exploration of Kidney

    CPT-50020-OPEN-DRAINAGE-RENAL-PERIRENAL-ABSCESS

    CPT 50020: Open Drainage of Renal or Perirenal Abscess

    CPT-50045-URINARY-OBSTRUCTION-RELIEF-SURGICAL-PROCEDURE

    CPT 50045: Surgical Relief of Urinary Tract Obstruction

    CPT-50060-SURGICAL-REMOVAL-KIDNEY-STONE

    CPT 50060: Surgical Removal of Kidney Stones (Nephrolithiasis)

    CPT-50065-NEPHROLITHOTOMY-SECONDARY-PROCEDURE-RENAL-STONE-REMOVAL

    CPT 50065: Nephrolithotomy for Kidney Stone Removal

    CPT-50070-KIDNEY-INCISION-STONE-REMOVAL-CONGENITAL-MALFORMATION

    CPT 50070: Nephrolithotomy for Renal Calculi with Kidney Malformation

    CPT-50075-OPEN-NEPHROLITHOTOMY-STAGHORN-CALCULUS-REMOVAL

    CPT 50075: Nephrolithotomy for Staghorn Renal Calculus

    CPT-50080-PERCUTANEOUS-ANTEGRADE-RENAL-STONE-REMOVAL-SIMPLE

    CPT 50080: Percutaneous Nephrolithotomy, Antegrade Stone Removal (Simple)

    CPT-50081-PERCUTANEOUS-ANTEGRADE-RENAL-URETERAL-STONE-REMOVAL-COMPLEX

    CPT 50081: Percutaneous Antegrade Removal of Kidney/Ureteral Stones

    CPT-50100-UPJ-REPAIR-RENAL-VESSEL-REPOSITIONING

    CPT 50100: Reposition/Incision of Aberrant Renal Vessels for UPJ Obstruction

    Showing 1–10 of 13

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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