Summary & Overview
CPT 50435: Percutaneous Nephrostomy Catheter Exchange with Image Guidance
CPT code 50435 represents an image-guided percutaneous exchange of a nephrostomy catheter, including optional nephrostogram and ureterogram with radiological supervision and interpretation. This procedure is clinically important for restoring or maintaining urinary drainage when the renal pelvis or ureter is obstructed, and it is commonly performed in interventional radiology settings. Nationally, the code is relevant for hospital outpatient departments, ambulatory surgical centers, and interventional suites where image-guided urinary drainage procedures occur.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks for clinical and billing practice, context on the clinical indications and typical settings, and a summary of common billing modifiers and coding considerations. The publication outlines expected service lines and payer coverage patterns, highlights documentation elements tied to the procedure description, and summarizes typical sites of service and the nature of imaging guidance used.
The content provides practical, nationally focused context for coding, billing, and administrative staff, as well as clinicians who refer or perform image-guided nephrostomy catheter exchanges. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 50435 describes a percutaneous exchange of a nephrostomy catheter using ultrasound and/or fluoroscopic guidance. The procedure involves replacing or exchanging a nephrostomy tube placed through the skin to divert urine around an obstruction in the renal pelvis or ureter. The provider may perform a nephrostogram and/or ureterogram by injecting contrast material to image internal renal and ureteral structures. The coded service covers the complete diagnostic and therapeutic exchange procedure, including radiological supervision and interpretation.
Service Type
- Interventional radiology procedure involving image-guided percutaneous catheter exchange and diagnostic contrast imaging.
Typical Site of Service
- Hospital outpatient department, ambulatory surgical center, or interventional radiology suite where image-guided percutaneous procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 67-year-old male with a left-sided obstructing proximal ureteral stone presents with rising creatinine and flank pain. An interventional radiology consult is obtained for urgent urinary decompression. Under conscious sedation in the IR suite, the interventional radiologist uses ultrasound guidance to access the renal collecting system and places a percutaneous nephrostomy catheter. Fluoroscopy is used to exchange the existing nephrostomy catheter for a new catheter and to perform a nephrostogram with contrast to confirm catheter position and assess ureteral patency. The procedure includes real-time imaging, injection of contrast for nephrostogram/ureterogram, catheter manipulation and securement, and radiological supervision and interpretation.
Typical clinical workflow:
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Pre-procedure: History, anticoagulation review, informed consent, basic labs and coagulation status confirmed.
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Procedure: Patient positioned in IR suite or procedure room; sterile technique; ultrasound and fluoroscopy used for access and catheter exchange; contrast injected for nephrostogram/ureterogram; catheter secured and dressing applied.
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Post-procedure: Immediate fluoroscopic images reviewed; nephrostomy output monitored; post-procedure instructions provided; documentation includes image interpretation and procedural details.
Coding Specifications
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