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Official Description

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

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 50694 involves the percutaneous placement of a ureteral stent, which is a medical device used to alleviate urinary obstruction. This obstruction may arise from various conditions such as kidney stones, tumors, or strictures that impede the normal flow of urine. The stent placement can also serve diagnostic purposes, allowing healthcare providers to assess urinary conditions, facilitate therapeutic interventions, or divert urine in cases of traumatic injury, leaks, fistulas, or hemorrhagic cystitis. The procedure is performed using imaging guidance, which may include ultrasound and/or fluoroscopy, to ensure accurate placement of the stent. The technique typically involves the use of a single or double needle approach, with careful insertion below the 12th rib to minimize complications such as puncturing the pleura. The process includes aspirating urine to confirm the correct location, injecting contrast dye for visualization, and threading a guidewire to position the stent appropriately within the urinary tract. The stent is designed to maintain urine flow from the kidney to the bladder, with specific configurations to ensure proper placement and function. This code encompasses all necessary imaging guidance, diagnostic procedures, and radiological supervision required during the stent placement process.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The placement of a ureteral stent via the percutaneous approach, as described by CPT® Code 50694, is indicated for several clinical scenarios, including:

  • Urinary Obstruction - This procedure is performed to treat urinary obstruction caused by conditions such as kidney stones, tumors, or strictures that block the normal flow of urine.
  • Diagnostic Purposes - It may be utilized to diagnose urinary conditions, providing essential information about the urinary tract's status.
  • Access for Therapeutic Interventions - The stent placement can provide access for further therapeutic interventions that may be necessary for managing urinary tract issues.
  • Urine Diversion - In cases of traumatic injury, leaks, fistulas, or hemorrhagic cystitis, the procedure can divert urine to prevent complications and promote healing.

2. Procedure

The procedure for the percutaneous placement of a ureteral stent involves several critical steps, which are detailed as follows:

  • Step 1: Preparation and Imaging Guidance - The procedure begins with the patient positioned appropriately, and imaging guidance is established using ultrasound and/or fluoroscopy. This imaging is crucial for visualizing the urinary tract and ensuring accurate needle placement.
  • Step 2: Needle Insertion - A single trocar or Chiba needle is inserted below the 12th rib, which is strategically chosen to minimize the risk of puncturing the pleura. The needle is advanced into the renal pelvis, where urine is aspirated to confirm the correct location and decompress the renal system.
  • Step 3: Contrast Injection and Visualization - Once the needle placement is verified, contrast dye is injected into the renal pelvis. A series of X-rays are taken to visualize the movement of the dye through the urinary tract, confirming the anatomy and the presence of any obstructions.
  • Step 4: Guidewire Placement - After satisfactory visualization, a thin guidewire is threaded through the needle into the renal pelvis and advanced down the ureter into the bladder, providing a pathway for the stent.
  • Step 5: Stent Insertion - The ureteral stent is then inserted over the guidewire and advanced into position. The proximal end of the stent is coiled within the renal pelvis, while the distal pigtail is positioned in the bladder. If a separate nephrostomy catheter is not inserted, the proximal end of the stent may remain outside the body or lie entirely within the renal system.
  • Step 6: Double Needle Technique (if applicable) - In cases where a double needle technique is employed, the first needle is inserted directly into the renal pelvis, and contrast dye is injected to obtain X-ray images. A small amount of air or CO2 may be injected to enhance visualization. A clamp is applied to the skin to mark the entry site for the second needle, which is placed under the 12th rib in the posterior axillary line. The insertion of the second needle and the placement of the stent or catheter follow the same procedure as the single needle technique.

3. Post-Procedure

After the procedure, patients are typically monitored for any immediate complications or adverse effects. The expected recovery may vary based on individual circumstances, but patients are generally advised to follow up with their healthcare provider to assess the stent's function and the resolution of the underlying urinary obstruction. Additional imaging may be required to ensure proper placement and function of the stent. Patients should also be informed about potential signs of complications, such as infection or stent migration, and instructed on any necessary post-procedure care.

Short Descr PLMT URETERAL STENT PRQ
Medium Descr PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH
Long Descr 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
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
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) 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 Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) I4B - Imaging/procedure - other
MUE 2

This is a primary code that can be used with these additional add-on codes.

50606 Addon Code MPFS Status: Active Code APC N ASC N1 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)
50705 Addon Code MPFS Status: Active Code APC N ASC N1 Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)
50706 Addon Code MPFS Status: Active Code APC N ASC N1 Balloon dilation, ureteral stricture, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)
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).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
GW Service not related to the hospice patient's terminal condition
LT Left side (used to identify procedures performed on the left side of the body)
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
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
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
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2017-01-01 Changed Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category.
2016-01-01 Added Added
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