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CPT® Code 50705
Add-On Code

Official Description

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)

Common Language Description

Ureteral embolization or occlusion is a medical procedure designed to block or interrupt the flow of urine from the kidneys to the bladder. This intervention is particularly indicated in cases where chronic or refractory lower urinary tract fistulas are present. Fistulas can develop due to various underlying conditions, including trauma, malignancy, or radiation exposure, which can compromise the normal urinary tract function. The procedure involves the use of imaging guidance, such as ultrasound and/or fluoroscopy, to ensure precise placement of instruments and to minimize complications. The process typically begins with the establishment of percutaneous access, where a trocar or Chiba needle is inserted below the 12th rib under imaging guidance. This careful approach helps to avoid injury to surrounding structures, such as the pleura. Once access is achieved, the renal pelvis is accessed, and urine is aspirated to confirm the correct location and relieve any pressure in the urinary system. Following this, a thin wire is threaded into the distal ureter, and a delivery catheter or access sheath is introduced to facilitate the insertion of embolic materials, such as stainless steel coils and gelatin sponge pledgets, which are used to occlude the ureter. The procedure is completed with additional imaging to confirm successful ureteral occlusion, and it is important to note that this code is listed separately in addition to the code for the primary procedure performed during the same session.

1. Indications

Ureteral embolization or occlusion is indicated for the following conditions:

Chronic Lower Urinary Tract Fistulas - This procedure is performed when there are persistent fistulas that disrupt normal urinary flow.
Refractory Lower Urinary Tract Fistulas - Indicated when fistulas do not respond to conservative management or other treatments.
Trauma - Fistulas resulting from traumatic injuries to the urinary tract may necessitate this intervention.
Malignancy - Tumors affecting the urinary tract can lead to the formation of fistulas, making embolization necessary.
Radiation Effects - Patients who have undergone radiation therapy may develop fistulas as a complication, warranting this procedure.

2. Procedure

The procedure for ureteral embolization or occlusion involves several critical steps:

Step 1: Establishing Access - The procedure begins with the establishment of percutaneous access. A trocar or Chiba needle is inserted below the 12th rib under ultrasound and/or fluoroscopic guidance. This careful placement is crucial to minimize the risk of puncturing the pleura, which could lead to complications.
Step 2: Confirming Location - Once the needle is in place, it is advanced into the renal pelvis. Urine is aspirated through the needle to verify the correct location and to decompress the renal system, ensuring that the procedure can be performed safely.
Step 3: Inserting the Wire - After confirming the needle's position, a thin wire is threaded through the needle into the distal ureter. This wire serves as a guide for subsequent steps in the procedure.
Step 4: Introducing the Catheter - A delivery catheter or access sheath is then inserted over the wire. In some cases, the wire may also be placed through an existing percutaneous tube or catheter into the ureter. This step is essential for delivering the embolic materials.
Step 5: Embolization - Once the catheter or sheath is in place, the wire is removed, and embolic agents, such as stainless steel coils and gelatin sponge pledgets, are inserted through the catheter or sheath to occlude the ureter effectively.
Step 6: Confirming Occlusion - After the embolic materials are placed, additional imaging is obtained to confirm successful ureteral occlusion. This imaging is part of the procedure and includes the necessary radiological supervision and interpretation.

3. Post-Procedure

Post-procedure care for patients undergoing ureteral embolization or occlusion typically involves monitoring for any immediate complications, such as bleeding or infection. Patients may be advised to maintain hydration and report any unusual symptoms, such as fever or increased pain. Follow-up imaging may be necessary to ensure the effectiveness of the occlusion and to assess for any potential complications. The recovery process can vary depending on the individual patient's condition and the complexity of the procedure performed.

Short Descr	URETERAL EMBOLIZATION/OCCL
Medium Descr	URETERAL EMBOLIZATION/OCCLUSION W/IMG GID RS&I
Long Descr	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)
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)	I4B - Imaging/procedure - other
MUE	2

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).
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).
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.
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