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Cutaneous appendico-vesicostomy, as defined by CPT® Code 50845, is a surgical procedure primarily performed in pediatric and young adult populations to address various urological conditions. This procedure is particularly indicated for patients suffering from neuropathic bladder conditions resulting from myelomeningocele, exstrophy-epispadias complex, cloacal anomalies, prune belly syndrome, and posterior urethral valves. The core objective of the appendico-vesicostomy is to create a channel using the appendix, known as a Mitrofanoff channel, which facilitates urinary drainage from the bladder to the exterior of the body. This channel is designed to be easily catheterized, providing a durable solution that can last throughout the patient's lifetime. The surgical technique involves mobilizing the right colon and the appendix, detaching the appendix from the cecum, and creating a connection between the bladder and the skin. This procedure not only enhances the quality of life for patients with complex urinary issues but also provides a reliable method for bladder management.
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The cutaneous appendico-vesicostomy is indicated for several specific conditions affecting the urinary system, particularly in pediatric and young adult patients. The following conditions are explicitly recognized as indications for this procedure:
The cutaneous appendico-vesicostomy procedure involves several detailed steps to ensure proper creation of the Mitrofanoff channel. The following procedural steps outline the process:
Post-procedure care for patients undergoing cutaneous appendico-vesicostomy includes monitoring for any signs of complications, such as infection or leakage at the stoma site. Patients are typically advised to maintain proper hygiene around the stoma to prevent infection. The temporary indwelling catheter will remain in place until the surgical wounds have healed adequately, at which point the patient can begin intermittent catheterization through the stoma. Follow-up appointments are essential to assess the healing process and the functionality of the Mitrofanoff channel, ensuring that the patient can effectively manage their urinary needs.
| Short Descr | APPENDICO-VESICOSTOMY | Medium Descr | CUTANANEOUS APPENDICO-VESICOSTOMY | Long Descr | Cutaneous appendico-vesicostomy | 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) | 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). | 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. | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 1994-01-01 | Added | First appearance in code book in 1994. |