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The procedure described by CPT® Code 50727 involves the revision of a urinary-cutaneous anastomosis, which pertains to any type of urostomy. A urostomy is a surgical opening created to divert urine away from the bladder when normal urinary function is compromised. This revision procedure is necessary when complications arise from the initial urostomy, which may include issues such as constriction or obstruction of the stoma, prolapse of urinary tract tissue through the stoma, retraction of the stoma below the skin level, detachment from the skin, necrosis of the tissue, or the development of a parastomal hernia. The revision process typically begins with a skin incision made around the entire circumference of the existing urostomy. Depending on the specific circumstances, local release of any scar tissue or adhesions may be performed. In more complex cases, dissection may extend through the fascia and peritoneum, allowing for resection of the distal portion of the urinary tissue, which is then everted and sutured back to the skin and subcutaneous tissue. If relocation of the stoma is required, the abdomen is opened at the new site, adhesions are lysed, and the exteriorized urinary tissue is mobilized. Any necrotic tissue is excised, and the terminal end of the urinary tissue is brought through the abdominal wall, folded back on itself, and sutured to the skin and subcutaneous tissue to ensure proper function and healing of the urostomy.
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The revision of urinary-cutaneous anastomosis is indicated in several specific scenarios related to the complications of an existing urostomy. These indications include:
The procedure for revising a urinary-cutaneous anastomosis involves several critical steps to ensure the proper function of the urostomy. The first step is to make a skin incision around the entire circumference of the existing urostomy. This incision allows access to the underlying structures and facilitates the necessary surgical interventions. Following the incision, the surgeon may perform a local release of any scar tissue or adhesions that have formed around the stoma, which can contribute to complications such as constriction or obstruction.
If the situation requires more extensive intervention, the dissection may continue deeper through the fascia and peritoneum. In this case, the distal portion of the urinary tissue may be resected to remove any damaged or necrotic tissue. The remaining urinary tissue is then everted, meaning it is turned inside out, and sutured back to the skin and subcutaneous tissue to create a secure and functional stoma.
In instances where the stoma needs to be relocated, the surgeon will open the abdomen at the new stoma site. This involves lysing any adhesions that may be present and mobilizing the exteriorized urinary tissue to ensure it can be properly positioned. Any necrotic tissue identified during the procedure is excised to promote healing and prevent infection. Finally, the terminal end of the urinary tissue is brought through the abdominal wall, folded back on itself (everted), and sutured to the skin and subcutaneous tissue, ensuring that the new stoma is functional and properly positioned.
After the revision of the urinary-cutaneous anastomosis, patients can expect a recovery period that may vary based on the complexity of the procedure and the individual’s overall health. Post-procedure care typically includes monitoring for any signs of complications such as infection, bleeding, or issues with the new stoma. Patients may be advised on proper stoma care and hygiene practices to ensure optimal healing and function. Follow-up appointments are essential to assess the stoma's condition and to make any necessary adjustments to care or management. Additionally, patients should be educated on recognizing signs of complications that may require further medical attention.
| Short Descr | REVISE URETER | Medium Descr | REVJ URINARY-CUTANEOUS ANASTAMOSIS | Long Descr | Revision of urinary-cutaneous anastomosis (any type urostomy); | 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 112 - Other OR therapeutic procedures of urinary tract |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code 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 | 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) | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| 2010-01-01 | Changed | Code description changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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