1 code page views remaining today. Guest accounts are limited to 2 daily page views. Register free account to get more views.
Log in Register free account

Official Description

Endoluminal biopsy of ureter and/or renal pelvis, non-endoscopic, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 50606 refers to an endoluminal biopsy of the ureter and/or renal pelvis that is performed using non-endoscopic techniques. This procedure is typically conducted in conjunction with other genitourinary interventions. The biopsy is facilitated through a catheter that has been previously positioned, such as for a nephrostogram or ureterogram. The process involves the placement of a guidewire to explore the ureteropelvic junction, allowing access to the ureter. Once the area of interest is identified, the catheter is maneuvered past the lesion or stricture, and the guidewire remains in place as the catheter is withdrawn. A sheath is then advanced over the guidewire to the targeted area, followed by the introduction of a specialized brush biopsy catheter. This catheter is used to obtain multiple samples from the lesion through brushings. After the biopsy samples are collected, they are placed in a container for laboratory analysis. The procedure also includes all necessary imaging guidance, such as ultrasound or fluoroscopy, along with the associated radiological supervision and interpretation. It is important to note that this code is considered an add-on code, meaning it should be reported in addition to the primary procedure performed.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The endoluminal biopsy of the ureter and/or renal pelvis, as described by CPT® Code 50606, is indicated for various clinical scenarios where tissue sampling is necessary. The following conditions may warrant this procedure:

  • Suspected Tumors Biopsy may be performed when there is a suspicion of malignancy in the ureter or renal pelvis, allowing for histological examination of the tissue.
  • Strictures The procedure is indicated in cases of ureteral strictures where abnormal tissue growth or narrowing is suspected, necessitating further investigation.
  • Unexplained Hematuria Patients presenting with unexplained blood in the urine may require a biopsy to determine the underlying cause, including potential neoplastic processes.
  • Infectious Processes In cases where an infection is suspected to involve the ureter or renal pelvis, a biopsy may help identify the causative organism or assess the extent of tissue involvement.

2. Procedure

The procedure for performing an endoluminal biopsy of the ureter and/or renal pelvis involves several critical steps, each designed to ensure accurate tissue sampling while minimizing patient risk. The following outlines the procedural steps:

  • Step 1: Catheter Placement Initially, a catheter is positioned within the urinary tract, typically for a nephrostogram or ureterogram. This step is crucial as it provides access to the ureter and renal pelvis for subsequent procedures.
  • Step 2: Guidewire Insertion A guidewire is then introduced through the catheter to facilitate exploration of the ureteropelvic junction. This guidewire serves as a navigational tool to reach the area of interest.
  • Step 3: Accessing the Lesion The catheter is carefully maneuvered past the identified lesion or area of stricture. This step is essential for ensuring that the biopsy is taken from the correct location.
  • Step 4: Sheath Advancement Once the lesion is accessed, the catheter is removed, leaving the guidewire in place. A sheath is then advanced over the guidewire to a position just beyond the target area, preparing for the biopsy.
  • Step 5: Brush Biopsy Catheter Introduction A specialized brush biopsy catheter is advanced through the sheath over the guidewire. This catheter is designed to collect tissue samples effectively.
  • Step 6: Sample Collection The sheath is retracted to a point just proximal to the target lesion, allowing the cytology brush to take several brushings of the lesion or mass. This step is critical for obtaining adequate tissue samples for analysis.
  • Step 7: Sample Handling After the brush biopsy catheter is removed, the collected brush with the tissue samples is placed in a container for laboratory analysis. Proper handling of the samples is vital for accurate diagnostic results.
  • Step 8: Removal of Equipment Finally, the sheath and guidewire are removed from the patient, completing the procedure.

3. Post-Procedure

Post-procedure care following an endoluminal biopsy of the ureter and/or renal pelvis typically involves monitoring the patient for any immediate complications, such as bleeding or infection. Patients may be advised to maintain hydration to facilitate urinary flow and help flush out any residual contrast material used during imaging. Follow-up appointments may be scheduled to discuss biopsy results and any further management based on the findings. It is essential for healthcare providers to provide clear instructions regarding signs of complications that patients should report, such as increased pain, fever, or changes in urinary output.

Short Descr ENDOLUMINAL BX URTR RNL PLVS
Medium Descr ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC
Long Descr Endoluminal biopsy of ureter and/or renal pelvis, non-endoscopic, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)
Status Code Active Code
Global Days ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Items and Services Packaged into APC Rates
ASC Payment Indicator Packaged service/item; no separate payment made.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P5E - Ambulatory procedures - other
MUE 1

This is an add-on code that must be used in conjunction with one of these primary codes.

50382 MPFS Status: Active Code APC J1 ASC G2 Physician Quality Reporting CPT Assistant Article Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation
50384 MPFS Status: Active Code APC Q2 ASC G2 Physician Quality Reporting CPT Assistant Article Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation
50385 MPFS Status: Active Code APC J1 ASC G2 Physician Quality Reporting PUB 100 CPT Assistant Article Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation
50386 MPFS Status: Active Code APC Q2 ASC P3 Physician Quality Reporting PUB 100 CPT Assistant Article Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation
50387 MPFS Status: Active Code APC J1 ASC G2 Physician Quality Reporting CPT Assistant Article Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation
50389 MPFS Status: Active Code APC Q2 ASC G2 Physician Quality Reporting CPT Assistant Article Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent)
50430 Resequenced Code MPFS Status: Active Code APC Q2 ASC N1 Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access
50431 Resequenced Code MPFS Status: Active Code APC Q2 ASC N1 Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access
50432 Resequenced Code MPFS Status: Active Code APC J1 ASC G2 Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
50433 Resequenced Code MPFS Status: Active Code APC J1 ASC G2 Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access
50434 Resequenced Code MPFS Status: Active Code APC J1 ASC G2 Convert nephrostomy catheter to nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, via pre-existing nephrostomy tract
50435 Resequenced Code MPFS Status: Active Code APC J1 ASC G2 Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
50684 MPFS Status: Active Code APC N ASC N1 Injection procedure for ureterography or ureteropyelography through ureterostomy or indwelling ureteral catheter
50688 MPFS Status: Active Code APC J1 ASC A2 Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit
50690 MPFS Status: Active Code APC N ASC N1 Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service
50693 MPFS Status: Active Code APC J1 ASC G2 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; pre-existing nephrostomy tract
50694 MPFS Status: Active Code APC J1 ASC G2 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, without separate nephrostomy catheter
50695 MPFS Status: Active Code APC J1 ASC G2 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, with separate nephrostomy catheter
51610 MPFS Status: Active Code APC N ASC N1 Injection procedure for retrograde urethrocystography
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
Date
Action
Notes
2017-01-01 Changed Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category.
2016-01-01 Added Added
Code
Description
Code
Description
Code
Description