© Copyright 2025 American Medical Association. All rights reserved.
An open ureteroneocystostomy is a surgical procedure that involves the reattachment of the ureter to the bladder. This procedure is specifically indicated when there is a need to create a new connection between the ureter and the bladder, often due to conditions that affect the normal function of the urinary tract. The distal ureter, which is the part of the ureter closest to the bladder, is carefully divided at or near the ureterovesical junction (UVJ), the point where the ureter meets the bladder. Following this, an incision is made in the dome of the bladder wall, extending down to the level of the mucosa, which is the innermost layer of the bladder. A smaller incision is then created in the bladder mucosa itself to facilitate the connection with the ureter. The detached segment of the ureter is then trimmed and its end is spatulated, which means it is shaped to create a larger surface area for the anastomosis, or surgical connection, to the bladder mucosa. This connection is crucial for ensuring that urine can flow from the ureter into the bladder without obstruction. After the ureter is attached, the bladder wall is closed over a 2-3 cm segment of the ureter, forming a tunnel that helps prevent the backflow of urine, known as reflux. The opening at the UVJ is subsequently closed to complete the procedure. In some cases, a temporary ureteral stent may be placed to maintain the patency of the ureter and facilitate healing during the recovery process. This procedure can be performed in various scenarios, including when a vesico-psoas hitch or bladder flap is utilized to accommodate anatomical variations or to enhance the surgical outcome.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure of ureteroneocystostomy with vesico-psoas hitch or bladder flap is indicated for several specific conditions and scenarios, including:
The ureteroneocystostomy procedure with vesico-psoas hitch or bladder flap involves several critical steps to ensure successful reattachment of the ureter to the bladder. The first step is the division of the distal ureter at or near the ureterovesical junction (UVJ). This is followed by making an incision in the dome of the bladder wall, which is carefully extended down to the mucosal layer. A smaller incision is then created in the bladder mucosa to allow for the connection with the ureter. Next, the detached segment of the ureter is trimmed to prepare it for anastomosis. The end of the ureter is spatulated, which increases the surface area for a more effective connection to the bladder mucosa. The full thickness of the ureter is then anastomosed to the bladder mucosa, ensuring a secure attachment. After this connection is made, the bladder wall is closed over a 2-3 cm segment of the ureter, creating a tunnel that helps prevent reflux of urine back into the ureter. Following the closure of the bladder wall, the opening at the UVJ is closed to complete the procedure. In cases where a vesico-psoas hitch is performed, the bladder is mobilized and sutured to the psoas muscle before the ureter is implanted. This fixation allows for a stable connection, and the bladder is incised at the point of fixation to accommodate the ureter. The ureter is then implanted in the immobile portion of the bladder along the line of fixation, utilizing a long submucosal tunnel. Alternatively, if the distal ureteral segment is too short, a bladder flap, also known as a Boari flap, may be created to facilitate the connection to the bladder.
After the ureteroneocystostomy procedure with vesico-psoas hitch or bladder flap, patients typically require careful monitoring and follow-up care. Post-procedure care may include the management of any temporary ureteral stents that were placed to ensure patency and promote healing. Patients are often advised to stay hydrated and may be monitored for signs of infection or complications, such as urinary leakage or obstruction. Recovery time can vary based on individual circumstances, but patients are generally expected to follow up with their healthcare provider to assess the success of the procedure and to ensure proper healing of the surgical site. Additional imaging studies may be performed to evaluate the function of the urinary tract and to confirm that the anastomosis is functioning as intended.
| Short Descr | REIMPLANT URETER IN BLADDER | Medium Descr | URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP | Long Descr | Ureteroneocystostomy; with vesico-psoas hitch or bladder flap | 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. | 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). | 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. | 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.) | 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). | 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) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) |
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