CPT Coding for Multiple Kidney Cyst Excision
The correct CPT code for excision of three kidney cysts is 50280 × 3.
Rationale for Code Selection
When coding for the excision of multiple kidney cysts, it's important to understand the specific CPT codes that apply to renal procedures:
50280: This code specifically describes "excision or unroofing of cyst(s) of kidney" and is the appropriate code for kidney cyst excision procedures 1.
Since three separate cysts were excised, the code should be reported three times (50280 × 3) to accurately reflect the work performed during the procedure 2.
Why Other Codes Are Incorrect
50290: This code represents "excision of perinephric cyst" which involves cysts located around the kidney rather than within the kidney parenchyma. Since the scenario specifically mentions kidney cysts (not perinephric cysts), this code is inappropriate 1.
50060: This code represents "nephrolithotomy; removal of calculus" which is used for kidney stone removal procedures, not cyst excision 1.
50280 (reported only once): This would be incorrect because it fails to account for the additional work involved in excising multiple separate cysts. When multiple distinct cysts are excised, the code should be reported for each cyst 2.
Clinical Context of Kidney Cyst Excision
Kidney cysts are categorized using the Bosniak Classification system, which helps determine management:
- Bosniak I and II cysts are typically benign and often require no intervention
- Bosniak IIF cysts have about 10% malignancy risk
- Bosniak III cysts have about 50% malignancy risk
- Bosniak IV cysts have 91-100% malignancy risk 1
Indications for surgical intervention of kidney cysts include:
- Growth to more than 3-4 cm
- Growth rate exceeding 0.5 cm per year
- Development of complex features
- Symptoms such as pain, hematuria, or infection
- Hypertension potentially related to the cyst 1
Surgical Approach Considerations
When performing kidney cyst excision:
- Partial nephrectomy is the preferred approach for cystic lesions when technically feasible, as it preserves renal function 3
- Nephron-sparing surgery should be considered whenever possible to preserve kidney function and reduce the risk of chronic kidney disease 3, 4
- For multiple cysts, each cyst should be individually addressed and documented in the operative report to support the use of multiple procedure codes 2
Coding Best Practices
When coding for multiple kidney cyst excisions:
- Document each cyst location and size
- Describe the separate work performed for each cyst
- Use modifier -59 if required by specific payers to indicate distinct procedural services
- Ensure the operative report clearly supports the coding of multiple procedures 2
By correctly coding this procedure as 50280 × 3, the physician will receive appropriate reimbursement for the work performed while accurately representing the procedure in the medical record.