Kidney Transplant

CPT 50360 · 38.88 wRVU · 90-day global

CPT50360

wRVU38.88

Global90-day

ApproachOpen

ComplexityComplex

Add-on / Variant CPTs

50365 wRVU: 44.98 — Renal transplant with concurrent recipient (native) nephrectomy (44.98 wRVU, 90-day global; use instead of 50360 when native kidney is removed at same session)
50323 wRVU: 0.0 — Backbench standard preparation of cadaveric donor renal allograft (separately billable — carrier-priced, no national wRVU; contact your MAC for local payment rate)
50325 wRVU: 0.0 — Backbench standard preparation of living donor renal allograft (separately billable — carrier-priced, no national wRVU; distinct from 50323 which is cadaveric only)
50327 wRVU: 3.9 — Backbench venous anastomosis reconstruction, each (3.90 wRVU; for venous extension grafts or accessory vein bench reconstruction)
50328 wRVU: 3.41 — Backbench arterial anastomosis reconstruction, each (3.41 wRVU; for Carrel patch creation, multiple arteries, or arterial bench reconstruction)
50329 wRVU: 3.26 — Backbench ureteral anastomosis reconstruction, each (3.26 wRVU)
50380 wRVU: 29.36 — Renal autotransplantation (29.36 wRVU)
50200 wRVU: 2.32 — Renal biopsy, percutaneous (2.32 wRVU, 0-day global; if intraoperative or postoperative biopsy performed)

Preoperative Diagnosis:

End-stage renal disease: [diabetic nephropathy / FSGS / IgA nephropathy / hypertensive nephrosclerosis / polycystic kidney disease]

Postoperative Diagnosis:

Same

Procedure Performed:

Deceased donor [/ living donor] renal transplant, right [/ left] iliac fossa

Attending Surgeon:

[Attending name], MD

First Assistant:

[Fellow/Resident name]

Anesthesia:

General endotracheal

Indications:

Patient presents with end-stage renal disease secondary to [etiology] on [hemodialysis / peritoneal dialysis] since [date]. [Preemptive transplant / living donor / deceased donor, PRA [X]%.] Cross-match [negative / virtual negative]. HLA mismatch [X]/6. CMV: donor [+/-], recipient [+/-]. Cold ischemia time [X] hours. Induction immunosuppression: [basiliximab / thymoglobulin]. Risks including delayed graft function, primary non-function, rejection, vascular thrombosis, ureteral leak, lymphocele, and death discussed. Consent obtained.

Findings:

Kidney [appeared viable / showed [some mottling / excellent perfusion] on back table]. Bench preparation included [ligation of accessory vessels / double renal arteries anastomosed to Carrel patch / venous extension graft]. Cold ischemia time: [X] hours. Second warm ischemia (anastomosis) time: [X] minutes. On reperfusion, kidney [pinked immediately / had delayed reperfusion]. [Urine output noted intraoperatively / no immediate urine output, consistent with delayed graft function].

Description of Procedure:

The patient was positioned supine. A [right / left] curvilinear iliac fossa (Gibson) incision was made. The external oblique, internal oblique, and transversalis fascia were divided. The retroperitoneal space was developed. The external iliac artery and vein were dissected free and controlled with vessel loops.

The kidney was brought to the field. The renal vein was anastomosed end-to-side to the external iliac vein using running [5-0 / 6-0 Prolene]. The renal artery was anastomosed end-to-side to the external iliac artery using running [5-0 / 6-0 Prolene]. Clamps released; [excellent perfusion, immediate turgidity and color change]. Urine noted in ureter within minutes of reperfusion.

Ureteroneocystostomy was performed using the [Lich-Gregoir extravesical technique / Politano-Leadbetter intravesical technique]. [Lich-Gregoir: the detrusor was incised, the ureter was anastomosed to the urothelium with running [4-0 Vicryl], and the detrusor was reapproximated over the ureter creating an antireflux tunnel.] A [double-J ureteral stent / no stent] was placed.

Hemostasis confirmed. [A closed-suction drain was placed near the hilum.] Fascia closed with running PDS. Skin closed with staples. Patient tolerated the procedure well.

Complications:

None

Specimens:

[Back-table tissue biopsy sent / None]

Estimated Blood Loss:

[X] mL

Drains:

[Closed-suction Jackson-Pratt drain / None]

Disposition:

Patient taken to transplant ICU / floor in stable condition.

Epic SmartPhrase Version

PREOPERATIVE DIAGNOSIS: End-stage renal disease: [diabetic nephropathy / FSGS / IgA nephropathy / hypertensive nephrosclerosis / PKD]
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Deceased donor [/ living donor] renal transplant, [right / left] iliac fossa
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: General endotracheal

INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with ESRD secondary to *** on [hemodialysis / peritoneal dialysis]. [Deceased donor / Living donor.] Cross-match negative. HLA mismatch ***. CMV D/R: ***. Cold ischemia time: *** hours. Induction immunosuppression: [basiliximab / thymoglobulin]. Risks including DGF, primary non-function, rejection, vascular thrombosis, ureteral leak, and lymphocele discussed. Informed consent obtained.

FINDINGS: Kidney appeared viable with [excellent / adequate] bench anatomy. [Double renal arteries / Carrel patch / Single artery.] Cold ischemia time: *** hours. Second warm ischemia (anastomosis) time: *** minutes. On reperfusion: [immediate turgidity and color change / delayed reperfusion]. [Urine output noted intraoperatively / no immediate urine output.]

DESCRIPTION OF PROCEDURE:
Patient supine. [Right / left] Gibson incision; retroperitoneal space developed; external iliac artery and vein dissected and controlled with vessel loops. Renal vein anastomosed end-to-side to external iliac vein with running 5-0 Prolene. Renal artery anastomosed end-to-side to external iliac artery with running 5-0 Prolene. Clamps released; excellent perfusion confirmed. Ureteroneocystostomy via Lich-Gregoir extravesical technique; [double-J ureteral stent placed]. Hemostasis confirmed. [JP drain placed at hilum.] Fascia closed with PDS; skin with staples. Patient tolerated the procedure well.

ESTIMATED BLOOD LOSS: *** mL
SPECIMENS: [Back-table biopsy to pathology / None]
COMPLICATIONS: None
DRAINS: [JP drain / None]
DISPOSITION: Patient to transplant [ICU / floor] in stable condition.

Signed: .ME, .MYDEGREE
.TODAY

Variants

Living donor kidney transplant

Same implantation technique. Note shorter cold ischemia time and typically better graft quality. Document donor relationship. Back-table preparation may be simpler (single artery, shorter ureter).

Dual kidney transplant (marginal donors)

Both kidneys placed in same recipient, typically from older or marginal donors. Document dual implantation, individual anastomoses, and rationale for dual placement.

Transplant with recipient nephrectomy

CPT 50365. Document indication for concurrent nephrectomy (infection, hypertension, massive polycystic kidneys). Performed through same Gibson incision or separate midline incision.

Charting Tips

Document cold ischemia time (from cross-clamp to cold flush in the donor OR) and second warm ischemia time (from removal of the allograft from ice to reperfusion in the recipient OR; i.e., anastomosis time). Both are OPTN-required data elements. If deceased donor, note donor KDPI/KDRI. If machine-perfused, document pump parameters (flow, resistance, preservation solution).
State number of renal arteries and veins and anastomotic technique for each
{'Note reperfusion quality': 'immediate vs. delayed, color, turgidity, urine output'}
Document ureteral stent use and planned removal date. Current evidence supports early removal at approximately 3 weeks (range 2-6 weeks); earlier removal (at or before 3 weeks) significantly reduces UTI risk (OR ~0.49 per meta-analysis) compared to later removal.
Record drain placement location and output at end of case
Induction immunosuppression agent should be in the operative note

Billing Tips

Bill 50360 for renal transplant implantation without recipient nephrectomy (38.88 wRVU, 90-day global). Bill 50365 when transplant includes a concurrent nephrectomy of the recipient's native kidney (44.98 wRVU).
Backbench preparation of the allograft prior to implantation is separately billable by the implanting surgeon: 50323 (cadaveric donor backbench prep) or 50325 (living donor backbench prep). These are in addition to 50360 and represent commonly missed RVU capture. What is NOT separately billable is the cadaveric donor nephrectomy itself (CPT 50300) — that is covered through organ acquisition cost, not the physician fee schedule.
Backbench vascular and ureteral reconstruction is separately billable per anastomosis: 50327 (venous anastomosis, each; 3.90 wRVU), 50328 (arterial anastomosis, each; 3.41 wRVU), 50329 (ureteral anastomosis, each; 3.26 wRVU). These apply to back-table work (Carrel patch creation, multiple arteries anastomosed, venous extension grafts, ureteral reconstruction). What IS bundled in 50360 is the in-vivo recipient iliac vessel anastomosis — do not bill 50327/50328 for the standard renal-to-iliac anastomosis performed in the recipient. Document all bench reconstruction explicitly.
90-day global period: biopsy of the transplanted kidney (use 50200 for percutaneous renal biopsy), rejection workup visits, and Doppler surveillance are not separately billable surgical fees within 90 days but generate radiology/pathology fees independently.
Immunosuppression management, biopsy interpretation, and nephrology co-management are physician E/M services billed independently by the respective providers and are not included in the surgical global.

General coding reference. Verify with your institution’s billing department before submitting claims.

ⓘ General Billing Tips →