Crystal's MCW Coder Hub🩺 CPT 50600 — Ureterotomy with Exploration or Drainage (Separate Procedure)
Code Descriptor
50600 — Ureterotomy with exploration or drainage (separate procedure)
This CPT code describes an open surgical incision into the ureter — performed for the purpose of exploring the ureteral lumen (to evaluate obstruction, stricture, foreign body, or pathology) and/or establishing drainage of an obstructed or infected ureteral segment. The parenthetical designation (separate procedure) is a critically important qualifier that signals this code describes a component service that, under normal circumstances, is bundled into larger, more complex procedures when performed at the same operative session. It is only reported independently when it stands alone as the sole or primary surgical objective of the operative encounter and is not performed as an integral, subordinate step of another reportable procedure.
The open ureterotomy involves a retroperitoneal or transperitoneal approach to expose the involved ureteral segment. A longitudinal incision is made directly into the ureter, the lumen is inspected or irrigated, the desired drainage or exploration is accomplished, and the ureteral wall is then closed primarily (ureterorrhaphy) or occasionally left open to drain if infection or necrosis precludes primary closure. A ureteral stent or nephrostomy tube may be placed to maintain patency during healing. While largely supplanted by ureteroscopy for most diagnostic and therapeutic ureteral indications, open ureterotomy remains relevant in cases where endoscopic access has failed, where dense periureteral fibrosis prevents safe ureteroscopy, or in the setting of complex reconstructive urology where open exposure is already established.
Understanding the “Separate Procedure” Designation
The phrase “separate procedure” in a CPT descriptor carries a very specific coding meaning that is one of the most commonly misunderstood concepts in surgical coding. It does not mean the procedure must be performed separately from other procedures on a different day. Rather, it signals that:
When 50600 is performed as an integral component of a larger, more complex procedure (such as ureterolithotomy, ureteral reimplantation, or pyeloplasty), it is bundled and should not be separately reported. The incision into the ureter is an inherent, expected step within those larger operations, and reporting 50600 alongside them would constitute unbundling — a coding compliance violation.
When 50600 is performed as the sole or primary operative objective of the encounter — meaning no other more comprehensive ureteral procedure is being performed — it may be reported independently. In that circumstance, the “(separate procedure)” designation simply reflects that this is a distinct, stand-alone service rather than a component service.
A helpful analogy: Think of a “separate procedure” code like a building block. When you’re assembling a complex structure (a more comprehensive procedure), the building block is already counted within it. But when you’re placing just that single block by itself, you absolutely count it. The terminology describes the code’s relationship to other procedures, not its scheduling context.
Companion / Related Ureter Incision and Exploration Codes
| CPT | Description |
|---|---|
| 50605 | Ureterotomy for insertion of indwelling stent, ureter (separate procedure) |
| 50610 | Ureterolithotomy; upper one-third of ureter |
| 50620 | Ureterolithotomy; middle one-third of ureter |
| 50630 | Ureterolithotomy; lower one-third of ureter |
| 50650 | Ureterectomy, with bladder cuff (separate procedure) |
| 50660 | Ureterectomy, total, ectopic ureter, combination abdominal, vaginal and/or perineal approach |
| 50700 | Ureteroplasty, plastic operation on ureter (e.g., stricture repair) |
| 50715 | Ureterolysis, with or without repositioning of ureter |
| 50722 | Ureterolysis for ovarian vein syndrome |
| 50725 | Ureterolysis for retrocaval ureter, with reanastomosis of upper urinary tract or vena cava |
| 50727 | Revision of urinary-cutaneous anastomosis (including revision of stoma) |
| 50728 | Revision of urinary-cutaneous anastomosis; with repair of fascial defect and hernia |
Key Distinction — 50600 vs. 50605: Both codes describe open ureterotomy, but 50605 is specifically used when the primary purpose of the ureterotomy is the insertion of a long-term indwelling ureteral stent via open technique. 50600 is for exploration and drainage where stent placement may or may not occur, but is not the stated primary goal of the incision. When stent insertion is the driving intent, 50605 is the correct code selection.
Anatomy & Clinical Context
Relevant Surgical Anatomy
The ureter is a paired, bilaterally symmetric, retroperitoneal muscular tube approximately 25-30 cm in length in adults. It courses from the renal pelvis inferiorly along the anterior surface of the psoas major muscle, crosses anterior to the common iliac vessels at the pelvic brim (a critically important anatomic landmark where ureteral injury during pelvic surgery frequently occurs), and descends within the pelvis before entering the posterolateral wall of the bladder at the ureterovesical junction (UVJ) through an oblique, antireflux intramural tunnel.
For procedural and coding purposes, the ureter is classically divided into three segments:
The upper one-third extends from the ureteropelvic junction (UPJ) to the upper edge of the sacrum and is most accessible via a flank or dorsal lumbotomy approach.
The middle one-third spans the sacrum and is approached via a lower midline or Gibson (oblique iliac) incision.
The lower one-third extends from the lower sacrum to the bladder and is typically approached via a lower midline, Pfannenstiel, or Gibson incision with medial reflection of the bladder.
There are three natural anatomic narrowings of the ureter where calculi most commonly lodge and obstruction most frequently occurs: the UPJ, the crossing at the iliac vessels (pelvic brim), and the UVJ. These are also the sites most prone to stricture formation from instrumentation, radiation, or inflammatory disease.
Blood Supply — Critical for Operative Safety
The ureteral blood supply is segmental and longitudinally oriented within the adventitia, which is why meticulous preservation of the periureteral adventitia is paramount during ureteral dissection. Devascularization of even short segments can lead to ischemic stricture or fistula formation postoperatively. The upper ureter is supplied by the renal and gonadal arteries, the middle ureter by branches of the aorta and common iliac arteries, and the lower ureter by branches of the internal iliac, superior vesical, and inferior vesical arteries.
Clinical Indications for Open Ureterotomy
While endoscopic (ureteroscopic) approaches have become the dominant minimality invasive standard for most ureteral pathology, open ureterotomy retains clinical relevance in a number of specific circumstances:
Ureteral Obstruction — Failed Endoscopic Management: When ureteroscopy cannot traverse a stricture or stone due to severe narrowing, kinking, angulation from prior surgery, or dense fibrosis, open ureterotomy with exploration provides direct access to the obstructed segment.
Ureteral Abscess or Periureteral Infection: When purulent material is loculated around or within the ureter (ureteral empyema or periureteral abscess), open drainage may be necessary, particularly when percutaneous drainage is not feasible.
Foreign Body Retrieval: Rarely, migrated stent fragments, calcified stents (“forgotten stents”), or other iatrogenic foreign material within the ureteral lumen may require open retrieval when endoscopic attempts fail.
Intraoperative Exploration During Open Reconstruction: When the ureter is already exposed during a complex reconstructive case (e.g., renal transplant, retroperitoneal tumor resection, aortic aneurysm repair) and its patency or integrity requires assessment, an open ureterotomy may be performed.
Ureteral Stricture Assessment: In select cases, ureterotomy with intraluminal inspection provides information about the mucosa and the length and character of a stricture that guides reconstruction planning.
Operative Technique (Open Ureterotomy)
The exact approach is dictated by the location of the ureteral pathology:
The patient is positioned in a flank, supine, or modified lithotomy position depending on the ureteral segment involved. A skin incision appropriate for the segment (flank for upper, oblique Gibson for middle/lower) is made. The retroperitoneal space is developed by medial reflection of the peritoneum and its contents. The ureter is carefully identified — frequently by its characteristic peristaltic motion when touched, its white glistening adventitia, and its anatomic relationships. A vessel loop or Babcock clamp is placed proximally and distally around the target segment to control spillage. A longitudinal ureterotomy is made with a fine scalpel or ureterotomy scissors. Exploration, stone extraction, foreign body removal, or drainage is accomplished. The lumen may be probed proximally and distally with a soft catheter or sound to assess patency. Closure is performed with fine absorbable suture (typically 4-0 or 5-0 polyglycolic acid or polyglactin) in an interrupted or running fashion over a double-J ureteral stent when technically feasible, with or without a retroperitoneal drain.
wRVU & Reimbursement
| Component | Value |
|---|---|
| wRVU | 9.94 |
| Work RVU (CMS) | 9.94 |
| Assistant Surgeon | ✅ Yes — payable |
| Co-Surgery | ✅ Permitted |
| Team Surgery | ✅ Permitted |
| Bilateral Surgery | ✅ Applicable — modifier -50 if both ureters explored |
| Global Period | 90 days |
| Facility Only | ✅ Yes — performed in hospital or ASC setting |
The 90-day global surgical period means that all routine post-operative care rendered within 90 days of the procedure date by the operating surgeon is included in the procedural payment. Separate E/M visits during this period require modifier -24 for unrelated medical conditions or modifier -25 when a separately identifiable, significant E/M service is provided on the same day as the procedure. If the patient requires return to the OR for a complication during the global period, modifier -78 is appended to the subsequent procedure.
Bilateral Modifier Note: If ureterotomy is performed on both ureters at the same operative session (e.g., bilateral ureteral exploration for bilateral obstruction), report 50600--50. Under the bilateral surgery payment rule, the total reimbursement is typically 150% of the single-procedure allowable — 100% for the primary side and 50% for the contralateral side, reflecting the shared operative setup and anesthesia time.
Modifiers Commonly Used
| Modifier | Clinical Indication |
|---|---|
| -22 | Increased procedural services — severe periureteral fibrosis from prior radiation, retroperitoneal fibrosis, dense adhesions from prior surgery, hostile retroperitoneum |
| -50 | Bilateral ureterotomy — both ureters explored at the same session |
| -51 | Multiple procedures — when 50600 is performed alongside other distinct, separately reportable procedures; appended to the lower-valued secondary procedure |
| -52 | Reduced services — procedure partially completed (e.g., unable to complete exploration due to hemodynamic instability) |
| -53 | Discontinued procedure — after anesthesia induction but unable to proceed safely |
| -59 | Distinct procedural service — used to clarify 50600 is a separately identifiable service from other procedures performed when NCCI edits would otherwise bundle them, and a more specific modifier (XE, XS, XU, XP) does not apply |
| -78 | Return to OR during global period for treatment of complication |
| -79 | Unrelated procedure or service performed during the global period |
| -80 | Assistant surgeon — payable for this procedure |
| -AS | Physician assistant, nurse practitioner, or clinical nurse specialist serving as assistant at surgery |
| -LT / [-[RT]] | Left / Right side — use when only one ureter is explored to specify laterality; may be required by certain payers |
Modifier -59 vs. X-modifiers: CMS introduced the X{EPSU} modifiers (-XE — separate encounter, -XS — separate structure, -XU — unusual non-overlapping service, -XP — separate practitioner) as more descriptive alternatives to -59. When unbundling 50600 from a related ureteral procedure using an NCCI modifier, consider whether one of the X-modifiers more precisely characterizes the distinction. Many commercial payers, however, continue to accept 59 broadly.
Common ICD-10-CM Diagnosis Codes
N20.1 — Calculus of Ureter
Description: A calculus (stone) lodged within the ureteral lumen, causing partial or complete obstruction of urinary flow. Ureteral calculi are the most common acute cause of ureteral obstruction and the most frequent indication for ureteral intervention. Stones may originate in the kidney and migrate distally, lodging at the UPJ, iliac vessel crossing, or UVJ — the three natural anatomic narrowings. Open ureterotomy (50600 or the ureterolithotomy codes 50610-50630) may be required when the stone is impacted beyond endoscopic retrieval.
- HCC: ❌ Not an HCC-mapped diagnosis
- POA (Present on Admission): Required for inpatient reporting
- MCC/CC Status: ✅ CC — ureteral calculus with obstruction carries CC weight
- Clinical Note: When a stone is confirmed by imaging and directly motivates the ureterotomy, N20.1 is the principal diagnosis. If obstruction with hydronephrosis is also present, assign N13.2 (hydronephrosis with renal and ureteral calculous obstruction) as the principal diagnosis, with N20.1 as a secondary code, depending on what condition drove the admission.
Includes: Ureteric stone, ureteral stone, ureterolithiasis
Excludes 1: Calculus of kidney with calculus of ureter — use N20.2 (calculi of kidney and ureter)
Laterality Coding Note: ICD-10-CM does not currently differentiate left from right for N20.1; laterality is not captured in this code.
N13.1 — Hydronephrosis with Ureteral Stricture, Not Elsewhere Classified
Description: Dilation of the renal collecting system (calyces and renal pelvis) resulting from obstruction at or below the level of the ureter, specifically due to ureteral stricture — a pathological narrowing of the ureteral lumen from scarring, fibrosis, prior instrumentation, ischemia, or extrinsic compression. This is a common indication for open ureteral exploration when the stricture has failed endoscopic management (balloon dilation, endoureterotomy).
- HCC: ❌ Not an HCC-mapped diagnosis
- POA: Required
- MCC/CC Status: ✅ CC
- Excludes 1: Hydronephrosis with ureteral stricture with infection — use N13.6 (pyonephrosis) when infection is present
N13.2 — Hydronephrosis with Renal and Ureteral Calculous Obstruction
Description: Combined diagnosis capturing both the obstructing calculus within the ureter or kidney and the resulting hydronephrosis. This is the preferred principal diagnosis code when a patient presents with a symptomatic obstructive stone causing documented renal pelvic dilation. It is a more specific and clinically complete descriptor than coding hydronephrosis and calculus separately.
- HCC: ❌ Not an HCC-mapped diagnosis
- POA: Required
- MCC/CC Status: ✅ CC
- Excludes 1: N13.2 with infection — in that case, use N13.6 (pyonephrosis)
N13.5 — Crossing Vessel and Stricture of Ureter without Hydronephrosis
Description: Obstruction or intermittent obstruction of the ureter by an aberrant crossing blood vessel (most commonly at the UPJ) or a stricture, without frank hydronephrosis identified on current imaging. May be an incidental finding or represent early/intermittent obstruction evaluated via open exploration.
- HCC: ❌ Not an HCC-mapped diagnosis
- POA: Required
- MCC/CC Status: Neither MCC nor CC
N13.6 — Pyonephrosis
Description: The accumulation of purulent (infected) material within an obstructed, dilated renal collecting system. Pyonephrosis is a urological emergency requiring urgent decompression — via percutaneous nephrostomy, ureteral stent, or open drainage. Open ureterotomy for drainage (50600) may be performed when less invasive approaches fail or are not anatomically feasible. This is one of the most clinically severe diagnoses in uropathology and carries significant coding weight.
- HCC: ❌ Not an HCC-mapped diagnosis
- POA: Required
- MCC/CC Status: ✅ MCC — pyonephrosis is a major complication/comorbidity at the MS-DRG level, reflecting its severity and resource intensity
- Clinical Note: When pyonephrosis is the indication for 50600, the presence of this MCC dramatically impacts MS-DRG assignment. Ensure the physician documents pyonephrosis explicitly rather than just “infected hydronephrosis” or “obstructed kidney with infection” — the specificity of the term matters for code assignment.
- Includes: Abscess of kidney; infected hydronephrosis; pyelitis with hydronephrosis; pyelonephritis with hydronephrosis; pyoureter
- Excludes 1: Calculous pyonephrosis — use N13.6 with an additional code for the calculus (N20.x)
N13.8 — Other Obstructive and Reflux Uropathy
Description: Captures obstructive uropathy due to causes not more specifically classified elsewhere, including periureteral fibrosis from retroperitoneal fibrosis (Ormond’s disease) when the ureter is encased but not from malignancy. Open ureterolysis (50715) is more commonly coded for this condition, but if ureterotomy with exploration is the primary operative objective, 50600 with N13.8 may be appropriate.
- HCC: ❌ Not an HCC-mapped diagnosis
- POA: Required
- MCC/CC Status: Neither
N11.1 — Chronic Obstructive Pyelonephritis
Description: Chronic kidney inflammation and fibrosis resulting from long-standing urinary obstruction, often with superimposed recurrent infection. Open ureteral exploration may reveal the level and nature of chronic obstruction contributing to progressive nephron loss. This diagnosis is important to capture as it reflects underlying pathology that justifies the procedure.
- HCC: ❌ Not an HCC-mapped diagnosis
- POA: Required
- MCC/CC Status: ✅ CC
N28.89 — Other Specified Disorders of Kidney and Ureter
Description: A broad catch-all code for documented ureteral pathology not captured by more specific codes. May be used for ureteral kinking, angulation, or tortuosity causing obstruction when a more specific code does not exist.
- HCC: ❌ Not an HCC-mapped diagnosis
- POA: Required
- MCC/CC Status: Neither
Q62.11 — Congenital Occlusion of Ureteropelvic Junction
Description: A congenital narrowing or functional obstruction at the ureteropelvic junction (UPJ obstruction) resulting in hydronephrosis. The most common congenital ureteral anomaly. While pyeloplasty (50400-50405) is the definitive surgical repair, open ureteral exploration near the UPJ may be coded with 50600 in select diagnostic or drainage scenarios distinct from reconstructive pyeloplasty.
- HCC: ❌ Not an HCC-mapped diagnosis
- POA: Required
- MCC/CC Status: ✅ CC — congenital obstructive anomalies of the ureter carry CC weight
| Code | Description |
|---|---|
| Q62.11 | Congenital occlusion of ureteropelvic junction |
| Q62.12 | Congenital occlusion of ureterovesical orifice |
| Q62.2 | Congenital megaureter |
| Q62.39 | Other obstructive defects of renal pelvis and ureter |
T19.8XXA — Foreign Body in Other Parts of Genitourinary Tract, Initial Encounter
Description: Used when open ureteral exploration is performed to retrieve a foreign body from the ureteral lumen, such as a fragmented or calcified ureteral stent, a migrated surgical clip, or other iatrogenic material. The seventh character “A” designates the initial encounter for treatment of this condition.
- HCC: ❌ Not an HCC-mapped diagnosis
- POA: Required
- MCC/CC Status: Neither
- Clinical Note: For calcified/encrusted forgotten stents (a distinct and well-recognized complication), also consider adding the appropriate complication of care code from the T83.x category if the foreign body is a medical device complication rather than a true exogenous foreign body.
T83.098A — Other Complication of Other Urinary Catheter, Initial Encounter
Description: Captures mechanical or obstructive complications of an indwelling ureteral catheter or stent (such as encrustation, migration, or kinking) that necessitates open ureteral exploration for management when less invasive approaches have failed.
- HCC: ❌ Not an HCC-mapped diagnosis
- MCC/CC Status: Neither — but if associated infection is present, additional organism codes can affect CC/MCC tier
C66.1 / C66.2 — Malignant Neoplasm of Right / Left Ureter
Description: Primary ureteral malignancy, most commonly urothelial carcinoma (transitional cell carcinoma of the ureter). Open ureteral exploration may be a component of the surgical approach for staging, biopsy access, or pre-resection assessment. More commonly, ureteral tumors require ureterectomy (50650, 50660) rather than simple ureterotomy alone.
- HCC: ✅ HCC 11 — Colorectal, Bladder, and Other Urinary Tract Cancers (CMS-HCC V24)
- HCC V28: Maps to HCC 17 (Kidney, Bladder, and Other Urinary Tract Cancers)
- RAF Score Contribution: Significant — active urinary tract malignancy carries substantial HCC weight
- POA: Required
- MCC/CC Status: ✅ MCC — active malignancy codes are typically MCC-level diagnoses
| Code | Description |
|---|---|
| C66.1 | Malignant neoplasm of right ureter |
| C66.2 | Malignant neoplasm of left ureter |
| C66.9 | Malignant neoplasm of unspecified ureter |
N39.0 — Urinary Tract Infection, Site Not Specified
Description: A secondary diagnosis when UTI is present concurrently with the primary ureteral condition requiring surgical intervention. Frequently documented alongside obstruction, stone disease, or stent complications. When the specific organism is identified in cultures, always code the organism additionally (e.g., B96.20 for E. coli, B96.1 for Klebsiella pneumoniae).
- HCC: ❌ Not an HCC-mapped diagnosis
- MCC/CC Status: Neither on its own, but organism-specific complicated UTI codes may achieve CC status
N20.0 — Calculus of Kidney
Description: Used as a secondary or co-existing diagnosis when renal calculi are present alongside ureteral calculi or obstruction. Important to capture for complete clinical documentation, particularly when imaging demonstrates bilateral or multiple calculi.
- HCC: ❌ Not an HCC-mapped diagnosis
- MCC/CC Status: Neither on its own
MS-DRG Assignment
As with other urological CPT codes, inpatient MS-DRG assignment is governed by ICD-10-PCS procedure codes and the ICD-10-CM diagnosis profile. The CPT code 50600 maps to the following ICD-10-PCS root operation for inpatient reporting purposes.
ICD-10-PCS Equivalent:
| PCS Code | Description |
|---|---|
| 0T960ZZ | Drainage of Right Ureter, Open Approach |
| 0T970ZZ | Drainage of Left Ureter, Open Approach |
| 0T980ZZ | Drainage of Bilateral Ureters, Open Approach |
| 0TJ60ZZ | Inspection of Right Ureter, Open Approach |
| 0TJ70ZZ | Inspection of Left Ureter, Open Approach |
The root operation assigned depends on the primary objective of the ureterotomy: if the intent is drainage of an obstructed or infected segment, the root operation is Drainage (9). If the primary intent is inspection of the ureteral lumen for diagnostic purposes, the root operation is Inspection (J). When both occur, code the more definitive root operation. When a calculus is removed through the ureterotomy, the root operation becomes Extirpation (C) (taking or cutting out solid matter — a calculus — from a body part), and different PCS codes apply.
Likely MS-DRG Groupings (MDC 11 — Diseases and Disorders of the Kidney and Urinary Tract):
| MS-DRG | Description | GMLOS |
|---|---|---|
| 673 | Other Kidney and Urinary Tract Procedures with MCC | 9.4 |
| 674 | Other Kidney and Urinary Tract Procedures with CC | 5.7 |
| 675 | Other Kidney and Urinary Tract Procedures without CC/MCC | 3.4 |
DRG Optimization Guidance: The single most impactful variable in MS-DRG assignment for 50600-related admissions is thorough comorbidity and complication capture. Pyonephrosis (N13.6) as principal diagnosis is an MCC, automatically grouping to DRG 673. Hydronephrosis with calculous obstruction (N13.2) is a CC, grouping to DRG 674 at minimum. When neither a CC nor MCC is captured, the case falls to DRG 675, the lowest-reimbursement tier. Targeted physician queries for the following underdocumented but clinically present conditions can meaningfully improve DRG weight: acute kidney injury (N17.x — CC or MCC depending on stage), sepsis (A41.x — MCC), malnutrition (E43 — MCC), metabolic acidosis (E87.2 — MCC), and respiratory failure (J96.x — MCC).
Code Tree — CPT Urinary System: Ureter — Incision (50600-50630)
Urinary System — Ureter
└── Incision
├── [[50600]] ◄◄ Ureterotomy with exploration or drainage (separate procedure)
├── [[50605]] — Ureterotomy for insertion of indwelling stent (separate procedure) ├── [[50610]] — Ureterolithotomy; upper one-third of ureter
├── [[50620]] — Ureterolithotomy; middle one-third of ureter
└── [[50630]] — Ureterolithotomy; lower one-third of ureter
[Extended Tree — Ureter Excision, Repair, Laparoscopic]
└── Excision
├── [[50650]] — Ureterectomy, with bladder cuff (separate procedure)
└── [[50660]] — Ureterectomy, total, ectopic ureter
└── Introduction
├── [[50684]] — Injection procedure for ureteropyelography
├── [[50686]] — Manometric studies through nephrostomy or pyelostomy tube
├── [[50688]] — Change of ureterostomy tube or externally accessible ureteral stent
└── [[50690]] — Injection for ureteropyelography via ureterostomy or indwelling ureteral catheter
└── Repair
├── [[50700]] — Ureteroplasty (stricture repair)
├── [[50706]] — Balloon dilation, ureteral stricture
├── [[50715]] — Ureterolysis (with or without repositioning)
├── [[50722]] — Ureterolysis for ovarian vein syndrome
├── [[50725]] — Ureterolysis for retrocaval ureter
├── [[50727]] — Revision of urinary-cutaneous anastomosis
├── [[50728]] — Revision of urinary-cutaneous anastomosis with fascial repair
├── [[50740]] — Ureteropyelostomy (ureterocalycostomy)
├── [[50750]] — Ureterocalycostomy
├── [[50760]] — Ureteroureterostomy
├── [[50770]] — Transureteroureterostomy
├── [[50780]] — Ureteroneocystostomy; single
├── [[50782]] — Ureteroneocystostomy; duplicated ureter
├── [[50783]] — Ureteroneocystostomy; with extensive ureteral tailoring
└── [[50785]] — Ureteroneocystostomy; with vesico-psoas hitch or bladder flap
└── Laparoscopy
├── [[50945]] — Laparoscopic ureterolithotomy
├── [[50947]] — Laparoscopic ureteroneocystostomy
└── [[50948]] — Laparoscopic ureteroneocystostomy with cystoscopy and ureteral stent
Includes
- Open surgical incision (ureterotomy) of the right, left, or bilateral ureter for the primary purpose of exploration or drainage
- Retroperitoneal or transperitoneal dissection to expose the target ureteral segment
- Inspection of the ureteral lumen (intraluminal exploration) through the ureterotomy incision
- Irrigation of the ureteral lumen to relieve obstruction or clear debris
- Drainage of periureteral abscess, phlegmon, or purulent collection in conjunction with ureteral incision
- Intraoperative probing of the ureteral lumen proximally and distally to assess patency
- Primary closure of the ureterotomy incision (ureterorrhaphy) with or without ureteral stent placement
- Retroperitoneal drain placement
- Ureteral stent placement at the time of closure (when not the sole stated purpose — if stent placement is the primary goal, use 50605)
- Routine wound closure
Excludes / Do Not Report Separately
- 50610-50630 (Ureterolithotomy) — When a calculus is the target and is extracted through the ureterotomy, the ureterolithotomy codes are the correct choice rather than 50600. The ureterotomy incision is bundled within the lithotomy procedure.
- 50605 — When ureteral stent insertion is the primary operative objective of the ureteral incision; use 50605 rather than 50600.
- 50700 (Ureteroplasty) — When the ureterotomy is performed specifically to repair a ureteral stricture; the repair code takes precedence.
- 50715 (Ureterolysis) — When the primary objective is freeing the ureter from surrounding fibrosis or adhesions; ureterolysis is a distinct and separately coded procedure.
- 50780-50785 (Ureteroneocystostomy) — When ureterotomy is an inherent step within ureteral reimplantation; do not separately report 50600.
- 50400-50405 (Pyeloplasty) — Ureterotomy performed as part of UPJ reconstruction is bundled into the pyeloplasty code.
- 52330-52356 (Ureteroscopy with ureterolithotomy) — Endoscopic approaches are coded separately and are not interchangeable with open ureterotomy codes.
- 50820 (Ureterosigmoidostomy) — Ureterotomy performed as an integral component of urinary diversion is bundled.
- Nephrostomy tube insertion — If a nephrostomy tube is placed at the same session (e.g., for upper tract decompression), it may be separately reportable 50395) depending on whether it was the primary procedure or an adjunct; apply NCCI guidance.
- Bilateral modifier 50 — Do not forget: if performed bilaterally, 50600-50 is correct and the procedure is not reported twice on separate lines with LT and RT without 50 (payer preference may vary — confirm with payer policy).
NCCI (National Correct Coding Initiative) Considerations
Understanding NCCI edits is essential for compliance when 50600 appears alongside other ureteral procedure codes on the same claim. Several important bundling relationships exist:
Column 1 / Column 2 Edits (50600 as Column 2 — Bundled Service): 50600 is frequently the Column 2 (bundled) code when paired with more comprehensive ureteral procedures such as 50610-50630 (ureterolithotomy), 50700 (ureteroplasty), or 50715 (ureterolysis). In these situations, 50600 is considered an integral component, and reporting it separately constitutes unbundling unless a distinct, separate operative objective exists on a different ureteral segment — in which case modifier 59 or an X-modifier may apply with supporting documentation.
Nephrostomy Codes (50040) — When percutaneous nephrostomy tube placement accompanies open ureterotomy at the same session, NCCI may bundle the nephrostomy as a Column 2 service. If the nephrostomy is placed at a distinctly separate anatomic site for a separate, independently justified purpose, modifier 59 may allow separate reporting.
Cystoscopy and Ureteroscopy Codes — Intraoperative cystoscopy or flexible ureteroscopy used solely to guide wire passage or stent confirmation during open ureterotomy is bundled and should not be separately reported. If a fully distinct diagnostic ureteroscopy of a separate ureteral segment is performed with separate clinical findings, separate reporting with modifier 59 and thorough documentation may be supportable.
Coding Examples
Example 1 — Isolated Open Ureterotomy for Exploration (Straightforward)
A 54-year-old male with a history of prior retroperitoneal surgery presents with a right ureteral stricture causing moderate hydronephrosis. Ureteroscopy has been attempted twice and was unable to traverse the stricture. He undergoes open right ureterotomy via a Gibson incision. The ureter is opened longitudinally, the stricture is inspected and found to be approximately 1.5 cm in length. A double-J stent is placed across the narrowing, and the ureter is closed primarily. No formal ureteroplasty is performed — this is an exploration and drainage procedure only, with reconstructive repair planned as a staged second procedure.
Report: 50600 Diagnosis (Principal): N13.1 (Hydronephrosis with ureteral stricture) Secondary Diagnosis: N11.1 (Chronic obstructive pyelonephritis, if documented) Modifier: RT (Right side — payer preference) or none, per payer guidance
Example 2 — Drainage of Pyonephrosis via Open Ureterotomy (High-Acuity Inpatient)
A 67-year-old female presents septic with right-sided pyonephrosis from a large impacted mid-ureteral stone. Interventional radiology is unavailable, and the urologist proceeds with open right ureterotomy for drainage. The obstructing calculus is palpable but friable and partially evacuated through the ureterotomy; formal stone extraction is not possible. The ureter is irrigated copiously, a stent is placed, and a retroperitoneal drain is left in place. The calculus is not fully removed at this session.
Report: 50600 (drainage is the primary objective; stone extraction is incomplete — if stone is fully extracted, 50620 for mid-ureteral lithotomy would apply) Principal Diagnosis: N13.6 (Pyonephrosis — MCC) Secondary Diagnoses: N20.1 (Calculus of ureter), A41.9 (Sepsis, unspecified — if sepsis criteria met, MCC), N17.9 (Acute kidney injury — CC if documented) MS-DRG: 673 (Other Kidney and Urinary Tract Procedures with MCC) — multiple MCC-level diagnoses present
💡 Coding Tip:
Example 3 — Foreign Body Retrieval (Calcified Forgotten Stent)
A 71-year-old male was found to have a severely encrusted, calcified double-J ureteral stent placed 4 years prior for ureteral obstruction from external compression. Endoscopic removal failed due to stent fragmentation and adherence to the ureteral wall. He undergoes open left ureterotomy for exploration and retrieval of the fragmented calcified stent material.
Report: 50600 Principal Diagnosis: T83.092A (Other mechanical complication of indwelling ureteral stent, initial encounter) Secondary Diagnoses: N20.1 if calculus encrustation is present, N13.1 (Hydronephrosis if obstruction documented) Modifier: LT (Left side)
Example 4 — Bilateral Ureterotomy for Exploration
A 58-year-old female with known retroperitoneal fibrosis (Ormond’s disease) presents with bilateral ureteral obstruction and rising creatinine. She undergoes bilateral open ureterotomy for exploration to assess the extent of ureteral involvement by fibrosis and to establish bilateral drainage pending definitive ureterolysis.
Report: 50600-50 Principal Diagnosis: N13.8 (Other obstructive and reflux uropathy — retroperitoneal fibrosis) Secondary Diagnoses: N18.3- (CKD Stage 3, if pre-existing and documented), N17.9 (AKI — CC if acute deterioration) Reimbursement: 150% of 50600 single allowable under bilateral surgery rule
Example 5 — Increased Complexity Modifier -22
A 63-year-old male with a history of prior sigmoid colectomy, appendectomy, and right ureterolithotomy for staghorn calculus disease presents with right ureteral obstruction. Open right ureterotomy is performed but requires 4 hours of operative time due to extremely dense retroperitoneal adhesions, bowel adherent to the right ureter throughout its entire length, and obliteration of the normal retroperitoneal tissue planes. The operative note documents the substantially increased difficulty relative to a standard ureterotomy.
Report: 50600--22 Diagnosis: N13.1 (Hydronephrosis with ureteral stricture) Secondary Diagnoses: Z87.39 (Personal history of genitourinary surgery), Z98.890 (Other specified post-procedural states) Note: Modifier -22 claims require a detailed operative note narrative explicitly articulating the factors that increased difficulty. A cover letter to the payer summarizing these factors is recommended. Expected reimbursement increase is typically 20-30% above the standard allowable.
Example 6 — Return to OR During Global Period
Two weeks following open right ureterotomy, the patient returns to the OR for urine leak from the ureterotomy closure site, presenting as a urinoma. The urologist re-explores the retroperitoneum, identifies and repairs the leak site, and places a new ureteral stent.
Report: Appropriate repair/revision code (e.g., 50700 for ureteroplasty or unlisted ureteral procedure 53899) -78 Diagnosis: T81.32XA (Disruption of internal operation wound, not elsewhere classified — initial encounter) or N99.89 (Other postprocedural complications of genitourinary system) Note: Modifier 78 signals return to OR for complication management during the global period. Payment is reduced (typically to the intraoperative component value only, approximately 70% of the total RVU) since pre- and post-operative care are already captured in the original global period.
Example 7 — Co-Surgery with General Surgery
A 60-year-old male undergoing open aortic aneurysm repair by vascular surgery develops intraoperative concern for left ureteral obstruction from the aneurysm. The urologist is called to the OR and performs open left ureterotomy for exploration and drainage as a co-surgeon managing the ureteral component while the vascular surgeon manages the aorta.
Urologist: 50600-62 Vascular Surgeon: Aortic repair code-62 (Each receives approximately 62.5% of the respective allowable)
Documentation Tips for Optimal Coding & Reimbursement
Thorough operative documentation is the foundation of accurate coding for 50600, and several specific elements should be addressed in every operative report to support correct code selection, modifier use, and MCC/CC capture.
The operative report must clearly state the primary operative objective — whether it was exploration, drainage, stone extraction, or stent placement. This single distinction determines whether 50600, 50605, 50610-50630, or another code is appropriate, and ambiguous language is the most frequent source of coding errors and audit risk in ureteral surgery.
Document the ureteral segment involved (upper, middle, or lower one-third) and the laterality (right, left, or bilateral), as these are essential for ICD-10-PCS coding in inpatient settings and for payer laterality requirements.
Document whether the ureteral incision was closed primarily (ureterorrhaphy) or left open, and whether a ureteral stent or drain was placed, as these details support the complexity of the service.
For inpatient cases, ensure that all clinically present comorbidities are explicitly named and attributed in the physician’s documentation — particularly acute kidney injury, sepsis, metabolic acidosis, malnutrition, and pyonephrosis — as these carry MCC or CC weight that drives DRG assignment. Lab values alone in nursing notes do not support code assignment; the attending physician must document the clinical condition in their notes or discharge summary.
When modifier 22 is used, the operative note should include a dedicated paragraph describing the specific anatomic or physiologic factors that made this case substantially more difficult than a standard ureterotomy, including estimated excess time, specific adhesion characteristics, and any unusual risks encountered.
For ICD-10-PCS accuracy on inpatient claims, coders should confirm with the physician whether the root operation was Drainage, Inspection, or Extirpation (removal of calculus), as these result in different PCS codes and may affect grouping.
Related CPT Codes (Cross-Reference)
| CPT | Description |
|---|---|
| 50605 | Ureterotomy for indwelling stent insertion (separate procedure) |
| 50610 | Ureterolithotomy, upper one-third of ureter |
| 50620 | Ureterolithotomy, middle one-third of ureter |
| 50630 | Ureterolithotomy, lower one-third of ureter |
| 50650 | Ureterectomy, with bladder cuff (separate procedure) |
| 50700 | Ureteroplasty (stricture repair) |
| 50715 | Ureterolysis, with or without repositioning |
| 50780 | Ureteroneocystostomy, single |
| 50820 | Ureterosigmoidostomy |
| 50945 | Laparoscopic ureterolithotomy |
| 52320 | Ureteroscopy with removal of ureteral calculus |
| 52344 | Ureteroscopy with treatment of ureteral stricture |
| 52356 | Ureteroscopy with lithotripsy (including ureteral stent placement) |
| 50040 | Nephrostomy, with or without pyelostomy |
| 50400 | Pyeloplasty, simple |
Quick Reference Summary
| Field | Detail |
|---|---|
| CPT | 50600 |
| Full Descriptor | Ureterotomy with exploration or drainage (separate procedure) |
| Approach | Open (retroperitoneal or transperitoneal) |
| wRVU | 9.94 |
| Global Period | 90 days |
| Assistant Payable | ✅ Yes |
| Facility Only | ✅ Yes |
| Bilateral | ✅ Yes — modifier 50 applies |
| Primary ICD-10 | N20.1, N13.1, N13.2, N13.6 |
| Highest-Value Dx | N13.6 (Pyonephrosis — MCC), C66.x (Ureteral malignancy — MCC/HCC) |
| HCC Diagnoses | C66.1 / C66.2 → HCC 11 (V24) / HCC 17 (V28) |
| MS-DRG | 673 / 674 / 675 |
| ”Separate Procedure” Meaning | Bundled when performed as part of a larger ureteral procedure; only report independently when it is the sole operative objective |
| Commonly Confused With | 50605 (stent insertion), 50610-50630 (stone extraction), 50700 (stricture repair) |
| Do NOT Separately Report With | 50610-50630, 50700, 50715, 50780-50785 |