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Official Description

Replacement of all or part of ureter by intestine segment, including intestine anastomosis

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 50840 involves the surgical replacement of all or part of the ureter using a segment of intestine. This is typically indicated when a section of the ureter is diseased or injured, necessitating its removal. The remaining healthy portion of the ureter is then connected to the intestine, allowing for the continuation of urinary flow. The surgery begins with an incision in the abdomen, through which the peritoneum is accessed. The small bowel is carefully isolated and moved out of the surgical area to provide a clear view of the ureter. The affected segment of the ureter is excised, and the distal end is ligated at the ureterovesical junction to prevent any leakage. A segment of the intestine, often the ileum, is selected based on the length required for the replacement. This segment is then prepared for anastomosis, which involves connecting it to both the ureter and the bladder. The procedure is intricate, requiring precise surgical techniques to ensure proper healing and function post-operation.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 50840 is indicated for the following conditions:

  • Ureteral Stricture: A narrowing of the ureter that can obstruct urine flow, often due to scarring or injury.
  • Ureteral Injury: Damage to the ureter that may occur from trauma, surgical complications, or other medical conditions.
  • Ureteral Tumors: Presence of tumors that necessitate the removal of a segment of the ureter.
  • Congenital Anomalies: Birth defects affecting the ureter that may require surgical intervention for proper urinary function.

2. Procedure

The procedure involves several critical steps to ensure successful ureteral replacement:

  • Step 1: An incision is made in the midline of the abdomen, allowing access to the peritoneal cavity. The peritoneum is opened to expose the internal organs.
  • Step 2: The small bowel is carefully isolated and packed out of the surgical field to provide a clear view of the ureter that needs to be addressed.
  • Step 3: The ureter is exposed and mobilized, allowing the surgeon to assess the extent of the disease or injury. The diseased segment of the ureter is then excised.
  • Step 4: The distal ureteral stump is ligated at the ureterovesical junction to prevent any leakage of urine.
  • Step 5: A segment of intestine, typically the ileum, is selected and mobilized. The required length for ureteral replacement is determined based on the surgical needs.
  • Step 6: The intestine is divided, and the isolated segment is prepared for anastomosis. The proximal and distal segments of the intestine are then anastomosed to restore bowel continuity.
  • Step 7: The isolated segment of intestine is prepared for connection to the ureter and bladder. The proximal end of this segment is closed with sutures.
  • Step 8: The ureter is spatulated, stented, and anastomosed to the proximal end of the isolated segment of intestine in an end-to-side fashion.
  • Step 9: The distal end of the isolated intestine is anastomosed to the bladder. An incision is made in the bladder wall, typically 1-2 cm posterolateral to the native ureteral orifice.
  • Step 10: A full-thickness segment of the bladder wall, matching the diameter of the distal segment of intestine, is excised to facilitate the anastomosis.
  • Step 11: The distal segment of intestine is then anastomosed to the bladder, ensuring proper connection for urine flow.
  • Step 12: A nephrostomy tube may be placed as needed to assist with urinary drainage during recovery.
  • Step 13: Finally, the surgical wound is closed in layers to promote healing and minimize complications.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as infection or leakage at the anastomosis sites. Patients may require a nephrostomy tube for urinary drainage, which will be managed until the urinary tract is functioning properly. Follow-up appointments are essential to assess the healing process and ensure that the anastomosis is functioning as intended. Patients are typically advised on activity restrictions and signs to watch for that may indicate complications, such as fever or increased pain.

Short Descr REPLACE URETER BY BOWEL
Medium Descr RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST
Long Descr Replacement of all or part of ureter by intestine segment, including intestine anastomosis
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).
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.
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).
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
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
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2002-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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