© Copyright 2025 American Medical Association. All rights reserved.
Ureteropyelostomy is a surgical procedure that involves the creation of an anastomosis, or connection, between the upper part of the ureter and the lower part of the renal pelvis. This procedure is specifically indicated for conditions such as ureteropelvic junction (UPJ) obstruction or a long proximal ureteral stricture, which can impede the normal flow of urine from the kidney to the bladder. In contrast to ureteropyelostomy, ureterocalycostomy is a related procedure that connects the ureter to the calyces, which are the cup-like structures in the kidney, at a point above the lower aspect of the renal pelvis. Ureterocalycostomy is typically performed when the renal pelvis is significantly fibrosed or scarred, making it unsuitable for direct anastomosis. During ureteropyelostomy, the surgeon carefully exposes and mobilizes the ureter while preserving the surrounding periureteral tissue. The procedure involves dividing the ureter just distal to the narrowed area, ligating the proximal ureteral stump, and mobilizing the kidney. The lower aspect of the renal pelvis is then excised above the obstructed segment, and the healthy proximal ureter is spatulated to facilitate the anastomosis. A stent is placed to ensure proper drainage during the healing process, and the ureteropelvic anastomosis is constructed over this stent, with additional reinforcement provided by perinephric fat or omentum to support the surgical connection.
© Copyright 2025 Coding Ahead. All rights reserved.
The ureteropyelostomy procedure is indicated for specific conditions that affect the normal function of the urinary system. These include:
The ureteropyelostomy procedure involves several critical steps to ensure successful anastomosis between the ureter and renal pelvis. The steps are as follows:
After the ureteropyelostomy procedure, patients typically require monitoring for any complications, such as leakage or infection. The stent placed during the procedure will usually remain in place for a specified duration to ensure proper urine drainage and to allow the anastomosis to heal adequately. Patients may experience some discomfort and will be advised on pain management strategies. Follow-up appointments are essential to assess the healing process and to determine when the stent can be safely removed. Additional imaging studies may be performed to evaluate the success of the procedure and the patency of the urinary tract.
| Short Descr | FUSION OF URETER & KIDNEY | Medium Descr | URETEROPYELOSTOMY ANAST URETER RENAL PELVIS | Long Descr | Ureteropyelostomy, anastomosis of ureter and renal pelvis | 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 |
| 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. | 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.) | 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). | 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) |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2019-11-01 | Changed | Medium Descriptor changed. |
| 2019-11-01 | Changed | Medium description changed per CPT Errata |
| Pre-1990 | Added | Code added. |