urostomy

DEFINITION of urostomy

A urostomy is an umbrella term for any form of urinary diversion in which urine is rerouted through a surgically created stoma on the abdominal surface. It is most commonly performed following cystectomy (bladder removal) due to bladder cancer, but is also indicated for neurogenic bladder, severe trauma, congenital anomalies, radiation damage, or intractable fistulas. The three major types are:

1. Ileal Conduit (Bricker Conduit) — most common urostomy: A segment of ileum (~15-20 cm) is isolated from the GI tract and one end is anastomosed to both ureters, while the other end is brought to the skin as a stoma. Urine drains continuously and is collected in an external appliance. It is an incontinent diversion — no voluntary control.
2. Cutaneous Ureterostomy: The ureter(s) are brought directly to the skin surface without using a bowel segment. Simpler but prone to stomal stenosis. Also incontinent. (See separate entry for full detail.)
3. Continent Cutaneous Urinary Reservoir (e.g., Indiana Pouch, Kock Pouch, Miami Pouch): A bowel segment is fashioned into an internal reservoir with a continent cutaneous stoma that the patient catheterizes intermittently. No external appliance needed. These are continent diversions and are significantly more complex to construct. A less common historical type is ureterosigmoidostomy, where ureters are implanted into the sigmoid colon and urine is expelled with stool — rarely performed today due to high complication rates.

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ETYMOLOGY of urostomy

greek Uro- Greek ouron (οὖρον)“Urine” -stomy Greek stoma (στόμα) “Mouth” or “opening” → surgical creation of an opening Full meaning”Surgical creation of a urinary opening”

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CODING AND NUANCES

🏥 ICD-10-CM Diagnosis Codes

Status Codes:

Code	Description
Z93.6	Other artificial openings of urinary tract status ✅ (covers ileal conduit, ureterostomy, continent reservoir stoma)

Complications — Incontinent External Stoma (ileal conduit, cutaneous ureterostomy):

Code	Description
N99.520	Hemorrhage of incontinent external stoma of urinary tract
N99.521	Infection of incontinent external stoma of urinary tract
N99.522	Malfunction of incontinent external stoma of urinary tract
N99.523	Herniation of incontinent stoma of urinary tract
N99.524	Stenosis of incontinent stoma of urinary tract
N99.528	Other complication of incontinent external stoma of urinary tract

Complications — Continent Stoma (Indiana pouch, Kock pouch, etc.):

Code	Description
N99.530	Hemorrhage of continent stoma of urinary tract
N99.531	Infection of continent stoma of urinary tract
N99.532	Malfunction of continent stoma of urinary tract
N99.533	Herniation of continent stoma of urinary tract
N99.534	Stenosis of continent stoma of urinary tract
N99.538	Other complication of continent stoma of urinary tract

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🔧 CPT Codes (Outpatient/Professional Reference)

Code	Description
50820	Ureteroileal conduit (ileal bladder), including intestine anastomosis
50825	Continent diversion, including intestine anastomosis using any segment of small/large intestine
50830	Urinary undiversion (e.g., reversal/takedown of urostomy with reconnection to bladder)
50750	Ureterocalycostomy
50780	Ureteroneocystostomy, single ureter to bladder (used in revision/reimplantation)

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📝 Inpatient Coder Notes

• Ileal conduit = TWO PCS codes, always: one from the urinary system (0T1x → ileum) and one from the GI system (0D1B → cutaneous). This is one of the most common multi-code procedure situations in urology inpatient coding. Do not miss the second code.
• Continent vs. incontinent is a critical distinction for complication coding: ileal conduit and cutaneous ureterostomy → N99.52x (incontinent); Indiana/Kock/Miami pouch → N99.53x (continent).
• Cystectomy coding: When a urostomy is performed in conjunction with a radical cystectomy, you will also need PCS codes for the cystectomy (resection of bladder, 0TTB0ZZ) and potentially lymph node dissection and prostatectomy/hysterectomy depending on the extent of the procedure — common in your radical cystectomy + ileal conduit cases.
• Device character: When the ileal conduit or continent reservoir is created using the patient’s own bowel with no synthetic graft, the device is typically Z (No Device) for the ureter-to-ileum bypass portion, or 7 (Autologous Tissue Substitute) if the bowel segment itself is considered the substitute — follow your facility’s PCS guidelines on this nuance.
• Z93.6 remains the correct status code across all urostomy types — there is no more granular ICD-10-CM status code specifically differentiating ileal conduit from continent pouch.

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🏥 ICD-10-PCS Codes (Inpatient)

⚠️ Critical PCS concept: A urostomy is coded based on the body part being bypassed and the destination qualifier. The ileal conduit requires two separate PCS codes: one for the urinary system bypass (ureter → ileum) and one for the GI system bypass (ileum → cutaneous).

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🔷 ILEAL CONDUIT — Step 1: Bypass Ureter(s) to Ileum

Code	Description
0T160ZA	Bypass Right ureter to Ileum, Open
0T1607A	Bypass Right Ureter to Ileum with Autologous Sub, Open
0T160JA	Bypass Right Ureter to Ileum with Synthetic Sub, Open
0T160KA	Bypass Right Ureter to Ileum with Nonautologous Sub, Open
0T164ZA	Bypass Right Ureter to Ileum, Perc Endo
0T164JA	Bypass Right Ureter to Ileum with Synthetic Sub, Perc Endo
0T170ZA	Bypass Left Ureter to Ileum, Open
0T1707A	Bypass Left Ureter to Ileum with Autologous Sub, Open
0T170JA	Bypass Left Ureter to Ileum with Synthetic Sub, Open
0T170KA	Bypass Left Ureter to Ileum with Nonautologous Sub, Open
0T174ZA	Bypass Left Ureter to Ileum, Perc Endo
0T174JA	Bypass Left Ureter to Ileum with Synthetic Sub, Perc Endo
0T180ZA	Bypass Bilateral Ureters to Ileum, Open
0T1807A	Bypass Bilateral Ureters to Ileum with Autologous Sub, Open
0T180JA	Bypass Bilateral Ureters to Ileum with Synthetic Sub, Open
0T180KA	Bypass Bilateral Ureters to Ileum with Nonautologous Sub, Open
0T184ZA	Bypass Bilateral Ureters to Ileum, Perc Endo

🔷 ILEAL CONDUIT — Step 2: Bypass Ileum to Cutaneous (GI System — always required as a second code)

Code	Description
0D1B0Z4	Bypass Ileum to Cutaneous, Open Approach
0D1B074	Bypass Ileum to Cutaneous with Autologous Sub, Open
0D1B0J4	Bypass Ileum to Cutaneous with Synthetic Sub, Open
0D1B0K4	Bypass Ileum to Cutaneous with Nonautologous Sub, Open
0D1B4Z4	Bypass Ileum to Cutaneous, Percutaneous Endoscopic

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🔷 CUTANEOUS URETEROSTOMY — Bypass Ureter(s) to Cutaneous (single code; see Ureterostomy entry for full list)

Code	Description
0T160ZD	Bypass Right Ureter to Cutaneous, Open
0T170ZD	Bypass Left Ureter to Cutaneous, Open
0T180ZD	Bypass Bilateral Ureters to Cutaneous, Open
0T164ZD	Bypass Right Ureter to Cutaneous, Perc Endo
0T174ZD	Bypass Left Ureter to Cutaneous, Perc Endo
0T184ZD	Bypass Bilateral Ureters to Cutaneous, Perc Endo

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DERIVATIONS of urostomy

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Query functionality

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Med roots Appendix A Prefixes Appendix B Combining Forms Appendix C Suffixes Appendix D Suffix forms