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An ureterolithotomy is a surgical procedure specifically designed to remove a calculus, commonly referred to as a stone, from the ureter, which is the duct that carries urine from the kidney to the bladder. This procedure is indicated when a stone obstructs the ureter, causing pain, infection, or other complications. The surgery involves making an incision in the abdomen, which may be located over the upper, middle, or lower ureter, depending on the precise location of the stone. During the operation, the abdominal wall muscles are carefully divided, and the peritoneum, the lining of the abdominal cavity, is pushed aside to access the ureter. Once the ureter is identified, it is meticulously dissected free from surrounding tissues, including the serosa and periureteral fat. The surgeon then locates the stone, which may be visually identified by a bulge in the ureter or through manual palpation. To facilitate the removal of the stone, vascular loops are placed above and below it to immobilize the ureter. An incision is made directly over the stone, allowing for its extraction. After the stone is removed, a catheter is inserted into the ureter for irrigation, ensuring that any remaining fragments are cleared. A drainage tube, such as a soft Penrose or suction tube, is then placed to facilitate drainage from the ureter. The ureter incision is carefully closed to avoid constriction, and the abdominal incision is closed around the drainage tube. This procedure is categorized under CPT® Code 50620, which specifically refers to the removal of stones from the middle one-third of the ureter, distinguishing it from similar procedures for the upper and lower segments of the ureter.
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The ureterolithotomy procedure is indicated for the following conditions:
The ureterolithotomy procedure involves several critical steps to ensure the successful removal of the stone from the ureter:
After the ureterolithotomy, patients are typically monitored for any signs of complications, such as infection or bleeding. The placement of a drainage tube allows for the continuous removal of urine and any residual fluid from the surgical site, which aids in recovery. Patients may experience some discomfort and are often prescribed pain management as needed. Follow-up appointments are essential to assess the healing process and ensure that the ureter is functioning properly. Additional imaging studies may be performed to confirm the complete removal of the stone and to monitor for any new stone formation.
| Short Descr | REMOVAL OF URETER STONE | Medium Descr | URTROLITHOTOMY MIDDLE ONE-THIRD URETER | Long Descr | Ureterolithotomy; middle one-third of ureter | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 112 - Other OR therapeutic procedures of urinary tract |
| 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2011-01-01 | Changed | Medium description changed. |
| Pre-1990 | Added | Code added. |