50780

🔱 CPT 50780 — Ureteroneocystostomy; Anastomosis of Single Ureter to Bladder

Full Descriptor: Ureteroneocystostomy; anastomosis of single ureter to bladder

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🧭 At a Glance

Field	Detail
CPT Code	50780
Code Family	Surgery / Urinary System
Section	50700-50980 (Ureter)
Laterality	Unilateral per descriptor; bilateral requires modifier -50 or two line items
wRVU	~15.27 (verify against current CMS Physician Fee Schedule)
Assistant Payable	✅ Yes — assistant surgeon payable under Medicare
Co-Surgery	✅ Eligible
Team Surgery	❌ Not typically reported as team surgery
Global Period	090 days
Facility vs. Non-Facility	Facility only (OR-level procedure)
Anesthesia	General
NCCI Edits	Multiple — see bundling section below

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📖 Detailed Description

CPT 50780 describes the surgical reimplantation of a single ureter into the urinary bladder, a procedure formally termed ureteroneocystostomy. This operation creates a new ureteral orifice by transecting the ureter at or near the ureterovesical junction (UVJ) and reattaching it to the bladder through a newly fashioned submucosal tunnel or orifice. The primary goals are to:

1. Restore or establish unobstructed urine flow from the kidney to the bladder
2. Eliminate vesicoureteral reflux (VUR) by creating an adequate antireflux mechanism through a submucosal tunnel (typically 4-5:1 tunnel-to-ureter diameter ratio)
3. Replace a damaged or stenotic distal ureter resulting from trauma, ischemia, instrumentation, or prior surgical injury
4. Reconstruct the ureter following oncologic resection of the distal ureter or bladder cuff

Operative Techniques Captured by 50780

50780 encompasses multiple surgical techniques for ureteral reimplantation of a single, non-duplicated ureter, all reportable under this single code regardless of the specific approach chosen:

Intravesical (Transvesical) Approaches

• Cohen Cross-Trigonal Reimplantation — The ureter is mobilized intravesically and tunneled transversely across the trigone in a submucosal plane to the contralateral side. Particularly common in pediatric VUR correction. Disadvantage: subsequent cystoscopic access to the ureteral orifice is difficult.
• Politano-Leadbetter Technique — The original intravesical approach; a new hiatus is created superior to the original ureteral hiatus, and the ureter is brought through a submucosal tunnel to a new trigonal orifice.
• Glenn-Anderson Technique — The ureter is advanced distally along the trigone toward the bladder neck within a submucosal tunnel; suited for short tunnels and larger ureteral diameters.

Extravesical Approaches

• Lich-Gregoir (Detrusorrhaphy) Technique — The detrusor muscle is incised extravesically without entering the bladder lumen, the mucosa is elevated, the ureter is laid into the trough, and the detrusor is reapproximated over the ureter. Does not require opening the bladder; preferred in adult urology and robotic-assisted surgery. Lower risk of bladder spasm and hematuria.

Laparoscopic and Robotic-Assisted Approaches

• Robotic-assisted ureteroneocystostomy (most commonly using the Lich-Gregoir approach extravesically) is increasingly performed. The CPT code does not change based on approach — 50780 applies regardless of open, laparoscopic, or robotic access.

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✅ Includes

• Dissection and mobilization of the distal ureter
• Excision of the stenotic or diseased ureteral segment (if applicable)
• Creation of a new ureteral orifice in the bladder wall
• Fashioning of a submucosal antireflux tunnel (for antireflux reimplantation)
• Mucosa-to-ureter or ureter-to-bladder anastomosis
• Ureteral stent placement if performed at the same session (stent placement is generally considered integral)
• Cystostomy (incidental bladder opening to perform reimplantation, if applicable)
• Drain placement
• Wound closure

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❌ Excludes / Parenthetical Notes

Excluded/Separate Service	Code	Notes
Ureteroneocystostomy with duplicated ureter	50782	Distinct code — use when a duplicated (bifid) ureter is reimplanted as a single anastomosis
Ureteroneocystostomy with extensive ureteral tailoring	50783	Use when megaureter requires tapering/tailoring of the ureter prior to reimplant
Ureteroneocystostomy with vesico-psoas hitch or Boari flap	50785	Use when bladder mobilization with psoas hitch or a Boari flap is required to bridge a longer ureteral defect — do not report 50780 separately when 50785 is billed
Transureteroureterostomy	50770	Anastomosis of one ureter to the contralateral ureter — a completely different procedure
Ureteroureterostomy	50760	End-to-end ureteral anastomosis — not a bladder reimplant
Kidney transplant with ureteroneocystostomy	50360, 50365	Transplant codes include ureteral reimplantation — do not separately report 50780 with renal transplant codes
Cystoscopy with ureteral stent placement	52332	If a stent is placed endoscopically in a separate session from the open reimplant, it may be separately reportable; if performed at the same session as part of the same surgical approach, it is generally bundled
Nephrectomy performed at same session	50220, 50234	May be separately reported with appropriate modifiers and documentation of distinctly separate procedures
Ureterolysis	50715	Release of ureteral adhesions/fibrosis — if performed as a distinct service not merely integral to the exposure for reimplantation, may be separately reportable with -59 and strong documentation
Psoas hitch alone (without Boari)	50785	50785 captures both psoas hitch and Boari flap scenarios
Laparoscopic ureteroneocystostomy	No distinct code	Report 50780 regardless of approach (open, laparoscopic, robotic); some payers require modifier -22 for significantly increased complexity of robotic cases with documentation

⚠️ Transplant Bundling Alert: When a renal transplant (50360, 50365) is performed with ureteral reimplantation into the native or transplanted bladder, 50780 is bundled and not separately reportable. The ureteroneocystostomy is considered inherent to the transplant procedure.

⚠️ NCCI Bundling Alert: 50780 has multiple NCCI column 2 edits. Particularly watch for bundling with bladder procedures, ureteroscopic procedures, and other ureteral codes performed at the same session. Always verify active NCCI edits prior to billing.

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🔗 Code Tree — Ureter Reconstruction/Anastomosis Family

Surgery → Urinary System → Ureter (50700-50980)
│
├── Repair / Reconstruction
│   ├── [[50700]] — Ureteroplasty, plastic operation on ureter (e.g., stricture)
│   ├── [[50715]] — Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis
│   ├── [[50722]] — Ureterolysis for ovarian vein syndrome
│   ├── [[50725]] — Ureterolysis for retrocaval ureter, with reanastomosis of upper urinary tract
│   │
│   ├── 🔵 URETERAL ANASTOMOSIS AXIS
│   │   ├── [[50750]] — Ureterocalycostomy, anastomosis of ureter to renal calyx
│   │   ├── [[50760]] — Ureteroureterostomy (end-to-end ureteral anastomosis)
│   │   ├── [[50770]] — Transureteroureterostomy (anastomosis of one ureter to contralateral ureter)
│   │   │
│   │   ├── 🔴 URETERONEOCYSTOSTOMY FAMILY
│   │   │   ├── [[50780]] — ⭐ Ureteroneocystostomy; single ureter to bladder
│   │   │   ├── [[50782]] — Ureteroneocystostomy; duplicated ureter to bladder
│   │   │   ├── [[50783]] — Ureteroneocystostomy; with extensive ureteral tailoring (megaureter)
│   │   │   └── [[50785]] — Ureteroneocystostomy; with vesico-psoas hitch or Boari flap
│   │   │
│   │   └── [[50800]] — Ureterotomy (cutaneous uretero-enterostomy)
│   │
│   └── [[50840]] — Replacement of all or part of ureter by intestinal segment

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🏥 Common ICD-10-CM Diagnoses Paired with 50780

🔴 Vesicoureteral Reflux (VUR) — Most Common Pediatric Indication

ICD-10-CM Code	Description	HCC	Notes
N13.70	Vesicoureteral-reflux, unspecified	❌ None	Use when laterality/grade not specified
N13.71	Vesicoureteral-reflux without reflux nephropathy	❌ None	VUR without renal parenchymal damage
N13.721	VUR with reflux nephropathy without hydroureter, unilateral	❌ None	Specify laterality with 7th character
N13.722	VUR with reflux nephropathy without hydroureter, bilateral	❌ None
N13.731	VUR with reflux nephropathy with hydroureter, unilateral	❌ None
N13.732	VUR with reflux nephropathy with hydroureter, bilateral	❌ None

💡 VUR Coding Tip: VUR grading (I-V) does not have distinct ICD-10-CM codes — the classification distinguishes by the presence of reflux nephropathy and hydroureter rather than grade. Document the nephropathy and hydroureter status in the clinical record to support code specificity.

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🟠 Ureteral Obstruction & Stricture

ICD-10-CM Code	Description	HCC	Notes
N13.0	Hydronephrosis with ureteropelvic junction obstruction	❌ None	UPJ obstruction — more proximal than typical for 50780; verify anatomy
N13.1	Hydronephrosis with ureteral stricture, NEC	❌ None	Distal ureteral stricture — common indication
N13.2	Hydronephrosis with renal and ureteral calculous obstruction	❌ None	Stone-related obstruction
N13.30	Hydronephrosis, unspecified	❌ None	Use only when cause not documented
N13.39	Other hydronephrosis	❌ None
N13.4	Hydroureter	❌ None	Dilated ureter without specified obstruction cause
N13.5	Crossing vessel and stricture of ureter without hydronephrosis	❌ None
N28.89	Other specified disorders of kidney and ureter	❌ None	Use when obstruction etiology is documented but doesn’t fit above

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🟡 Congenital Anomalies of Ureter — Pediatric Population

ICD-10-CM Code	Description	HCC	Notes
Q62.0	Congenital hydronephrosis	❌ None
Q62.10	Congenital occlusion of ureter, unspecified	❌ None
Q62.11	Congenital occlusion of ureteropelvic junction	❌ None
Q62.12	Congenital occlusion of ureterovesical orifice	❌ None	Directly applicable to distal ureteral obstruction at UVJ — very common indication
Q62.2	Congenital megaureter	❌ None	When megaureter present, assess whether 50783 is more appropriate
Q62.31	Congenital ureterocele, orthotopic	❌ None	Ureterocele at normal location — may require reimplantation after ureterocele repair
Q62.32	Cecoureterocele	❌ None
Q62.39	Other obstructive defect of renal pelvis and ureter	❌ None
Q62.5	Duplication of ureter	❌ None	If duplicated system, reassess whether 50782 is the correct code
Q62.60	Malposition of ureter, unspecified	❌ None	Ectopic ureter
Q62.61	Deviation of ureter	❌ None
Q62.62	Displacement of ureter	❌ None
Q62.63	Anomalous implantation of ureter	❌ None	Ectopic ureteral insertion requiring surgical repositioning
Q62.69	Other malposition of ureter	❌ None

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🟢 Iatrogenic / Traumatic Ureteral Injury

ICD-10-CM Code	Description	HCC	Notes
N99.89	Other postprocedural complications of genitourinary system	❌ None	Postoperative ureteral stricture
N99.121	Postprocedural bulbous urethral stricture (if applicable)	❌ None
T19.8XXA	Foreign body in other parts of GU tract, initial encounter	❌ None	Retained ureteral stent causing stricture
S37.12XA	Contusion of ureter, initial encounter	❌ None	Traumatic ureteral injury
S37.13XA	Laceration of ureter, initial encounter	❌ None
S37.19XA	Other injury of ureter, initial encounter	❌ None

💡 External Cause Coding: When ureteral injury is iatrogenic (e.g., injury during hysterectomy, colorectal resection, or vascular surgery), assign an appropriate external cause code from the Y83 series (surgical complication) in addition to the injury code.

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🔵 Renal Transplant-Related Indications

ICD-10-CM Code	Description	HCC	Notes
T86.10	Unspecified complication of kidney transplant	HCC 136	Transplant complications carry significant HCC weight
T86.11	Kidney transplant rejection	HCC 136
T86.12	Kidney transplant failure	HCC 136
T86.13	Kidney transplant infection	HCC 136
T86.19	Other complication of kidney transplant	HCC 136	Ureteral anastomotic stricture post-transplant — very common indication for reimplant
Z94.0	Kidney transplant status	❌ None (status code)	Always report as secondary code for transplant patients
N18.6	End-stage renal disease	HCC 136
N18.5	Chronic kidney disease, stage 5	HCC 138
N18.4	Chronic kidney disease, stage 4	HCC 138
N18.3-	Chronic kidney disease, stage 3 (unspecified)	HCC 138
N18.31	Chronic kidney disease, stage 3a	HCC 138
N18.32	Chronic kidney disease, stage 3b	HCC 138

💡 HCC Note: While VUR and congenital ureteral anomalies themselves are not HCC-mapped, the renal sequelae — particularly CKD stages 3-5 (N18.3—N18.5) and ESRD (N18.6) — carry significant HCC weight under CMS HCC v28. When reflux nephropathy or chronic obstruction has caused documented CKD, assign the CKD code in addition to the VUR/obstruction code. Transplant complications (T86.10-T86.19) map to HCC 136 and are among the highest-weighted categories.

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🟣 Malignancy-Related Indications (Ureteral Reconstruction After Resection)

ICD-10-CM Code	Description	HCC	Notes
C67.9	Malignant neoplasm of bladder, unspecified	HCC 11	Distal ureteral reimplant after bladder cuff excision
C67.6	Malignant neoplasm of ureteric orifice	HCC 11	Tumor at ureteral orifice requiring resection + reimplant
C66.1	Malignant neoplasm of right ureter	HCC 11	Distal ureteral tumor
C66.2	Malignant neoplasm of left ureter	HCC 11
C66.9	Malignant neoplasm of ureter, unspecified	HCC 11
C53.9	Malignant neoplasm of cervix uteri, unspecified	HCC 11	Ureteral injury/involvement from gynecologic malignancy
C54.1	Malignant neoplasm of endometrium	HCC 11

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🏨 MS-DRG Mapping

CPT 50780 maps to an OR procedure and will drive assignment to a surgical MS-DRG. The principal diagnosis largely determines the specific DRG pair, further refined by CC/MCC status:

Non-Neoplastic Diagnoses (VUR, Stricture, Congenital, Trauma)

MS-DRG	Description	Geometric Mean LOS
661	Kidney and Ureter Procedures for Non-Neoplasm with MCC	~6.8 days
662	Kidney and Ureter Procedures for Non-Neoplasm with CC	~3.5 days
663	Kidney and Ureter Procedures for Non-Neoplasm without CC/MCC	~2.3 days

Neoplastic Diagnoses (Ureteral/Bladder/Cervical Malignancy)

MS-DRG	Description	Geometric Mean LOS
671	Kidney and Ureter Procedures for Neoplasm with MCC	~9.2 days
672	Kidney and Ureter Procedures for Neoplasm with CC	~4.6 days
673	Kidney and Ureter Procedures for Neoplasm without CC/MCC	~2.9 days

Transplant-Related Diagnoses

MS-DRG	Description	Notes
652	Kidney Transplant	Only if transplant performed at same admission
661-663	Non-neoplasm kidney/ureter	Post-transplant ureteral stricture repair at a separate admission

💡 CC/MCC Capture Tips for This Population:

• MCCs commonly seen: sepsis/urosepsis, acute kidney injury (N17.9, MCC), respiratory failure, renal failure requiring dialysis
• CCs commonly seen: UTI (N39.0), ileus (K56.7), urinary retention (R33.9), DVT (I82.4x1), hyponatremia (E87.1), reflux nephropathy with documented CKD
• In pediatric inpatient cases, MS-DRG assignment may follow pediatric-specific DRG logic — verify payer-specific pediatric DRG assignment policies (some utilize APR-DRG systems)

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💉 ICD-10-PCS Procedure Codes (Inpatient)

For inpatient encounters, 50780 corresponds to ICD-10-PCS. The root operation is Reposition (S) when the ureter is moved from its natural location to a new site in the bladder, or Replacement (R) if a segment is replaced. In most cases, ureteral reimplantation is coded as Reposition:

ICD-10-PCS Code	Description
0TS60ZZ	Reposition right ureter, open approach
0TS70ZZ	Reposition left ureter, open approach
0TS64ZZ	Reposition right ureter, percutaneous endoscopic (laparoscopic/robotic)
0TS74ZZ	Reposition left ureter, percutaneous endoscopic
0TS680Z	Reposition right ureter with synthetic substitute, open
0TS780Z	Reposition left ureter with synthetic substitute, open

📝 PCS Note: If a Boari flap is created (bladder tissue used to bridge the gap), this may be coded as an Alteration or Repair of the bladder in addition to the ureteral Reposition. When the ureter is tailored (megaureter), an Excision of the ureter body part may also be separately coded per PCS guidelines. Confirm with your facility’s PCS coding guidelines and CDI team.

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🧪 Coding Examples

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✏️ Example 1 — Pediatric VUR, Open Cohen Cross-Trigonal Reimplantation (Outpatient/ASC)

Clinical Scenario: A 4-year-old female with Grade IV left vesicoureteral reflux with reflux nephropathy and hydroureter (N13.731) undergoes open intravesical left ureteroneocystostomy using the Cohen cross-trigonal technique. No ureteral tailoring is performed. A ureteral stent is placed at the time of the procedure.

CPT Reported:

• 50780 — Ureteroneocystostomy; anastomosis of single ureter to bladder (left side)

ICD-10-CM:

1. N13.731 — Vesicoureteral-reflux with reflux nephropathy with hydroureter, unilateral (PDX)

Notes: The ureteral stent placed at the time of the open reimplantation is integral to the procedure and not separately reportable. The Cohen technique is an intravesical approach captured within 50780. No tailoring was required, ruling out 50783. Laterality is unilateral left, so modifier is not needed, but -LT may be appended per payer preference.

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✏️ Example 2 — Robotic-Assisted Extravesical Reimplantation, Bilateral VUR

Clinical Scenario: A 6-year-old male with bilateral Grade III VUR without reflux nephropathy (N13.71) undergoes robotic-assisted bilateral extravesical ureteroneocystostomy using the Lich-Gregoir technique.

CPT Reported:

• 50780-50 — Ureteroneocystostomy; bilateral (or two line items with -LT and -RT per payer preference)

ICD-10-CM:

1. N13.71 — Vesicoureteral-reflux without reflux nephropathy (PDX)

Reimbursement Note: Bilateral reporting (50780-50) is reimbursed at 150% of the unilateral allowable under Medicare. The robotic approach does not change the CPT code. Some payers may require modifier -22 with operative note documentation if the robotic approach significantly increased complexity, but this is uncommon for a standard bilateral reimplant.

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✏️ Example 3 — Distal Ureteral Stricture, Post-Hysterectomy (Inpatient)

Clinical Scenario: A 52-year-old female develops left hydronephrosis (N13.1) secondary to a distal ureteral stricture attributed to iatrogenic injury sustained during a laparoscopic hysterectomy performed 8 weeks prior. She is admitted for open left ureteroneocystostomy with psoas hitch to bridge the 3 cm ureteral defect. She has documented stage 3b CKD (N18.32) and essential hypertension (I10).

CPT Reported:

• 50785 — Ureteroneocystostomy with vesico-psoas hitch (NOT 50780 — psoas hitch was required)

ICD-10-CM (Inpatient Sequencing):

1. N13.1 — Hydronephrosis with ureteral stricture (PDX)
2. N99.89 — Other postprocedural complications of genitourinary system (iatrogenic stricture etiology)
3. N18.32 — Chronic kidney disease, stage 3b (CC — affects management)
4. I10 — Essential hypertension

External Cause:

• Y83.8 — Surgical procedure as external cause of complication

MS-DRG:

• CKD stage 3b qualifies as a CC → MS-DRG 662 (Kidney and Ureter Procedures for Non-Neoplasm with CC)

⚠️ Critical Coding Decision: The operative note documents a psoas hitch to bridge the ureteral gap. This elevates the code from 50780 to 50785. Always carefully review the operative note to identify whether a psoas hitch or Boari flap was created — this distinction is a common source of undercoding in urology.

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✏️ Example 4 — Post-Renal Transplant Ureteral Stricture, Reimplantation (Inpatient)

Clinical Scenario: A 61-year-old male with a history of ESRD (N18.6) secondary to diabetic nephropathy (E11.65) and a functioning cadaveric renal transplant (Z94.0) presents with allograft hydronephrosis. Imaging confirms a ureteral anastomotic stricture. He is admitted for open revision ureteroneocystostomy of the transplant ureter. He also has type 2 diabetes (E11.9) and hypertension (I10).

CPT Reported:

• 50780 — Ureteroneocystostomy; anastomosis of single ureter to bladder (revision of the transplant ureter into the bladder; this is not a new transplant, so transplant codes do not apply)

ICD-10-CM (Inpatient Sequencing):

1. T86.19 — Other complication of kidney transplant (ureteral anastomotic stricture as transplant complication — PDX) — HCC 136
2. Z94.0 — Kidney transplant status
3. N18.6 — End-stage renal disease — HCC 136
4. E11.65 — Type 2 diabetes mellitus with hyperglycemia (if active)
5. I10 — Essential hypertension

MS-DRG:

• T86.19 with ESRD: ESRD (N18.6) qualifies as an MCC → MS-DRG 661 (Kidney and Ureter Procedures for Non-Neoplasm with MCC)

💡 HCC Impact: Both T86.19 (HCC 136) and N18.6 (HCC 136) are hierarchical within the same HCC category — they do not double-count but confirm HCC 136 capture. Ensure these are reported on all applicable claims throughout the year for accurate risk adjustment.

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✏️ Example 5 — Ureteral Reimplantation with Distal Ureteral Tumor Resection

Clinical Scenario: A 68-year-old male with a low-grade urothelial carcinoma involving the left distal ureter and ureteral orifice (C66.2, C67.6) undergoes open resection of the distal left ureter with bladder cuff excision and left ureteroneocystostomy. No psoas hitch or Boari flap required. Pelvic lymph node dissection was performed at the same session (external iliac, hypogastric, obturator — left sided).

CPT Reported:

• 50780-LT — Ureteroneocystostomy, left ureter to bladder
• 38770-LT — Pelvic lymphadenectomy, left (verify NCCI; if not bundled with 50780, report separately with -51 on secondary procedure)

ICD-10-CM:

1. C66.2 — Malignant neoplasm of left ureter (PDX — primary tumor site) — HCC 11
2. C67.6 — Malignant neoplasm of ureteric orifice — HCC 11 (if separately documented involvement)

MS-DRG:

• Malignant diagnosis → MS-DRG 673 (Kidney and Ureter Procedures for Neoplasm without CC/MCC) — unless CC/MCC present

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📎 Modifier Guidance

Modifier	Use Case
-50	Bilateral ureteroneocystostomy (both ureters reimplanted at same session)
-LT / -RT	Indicate laterality; required by some payers instead of or in addition to -50
-51	Multiple procedures — apply to lesser-valued procedure when 50780 is performed with other major procedures at same session
-22	Increased procedural complexity — with documentation; consider for unusually complex cases (dense adhesions, prior pelvic radiation, reoperative field)
-52	Reduced services — not typically applicable
-58	Staged/related procedure during global period (e.g., planned second-stage reconstruction during global of prior ureteral procedure)
-59	Distinct procedural service — use when a secondary procedure at same session is distinct and not bundled by NCCI (requires strong documentation)
-78	Unplanned return to OR for related procedure during global period (e.g., postoperative anastomotic leak requiring revision)
-80	Assistant surgeon
-82	Assistant surgeon when qualified resident not available

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📝 Operative Note Documentation Requirements

To support CPT 50780 (versus 50782, 50783, or 50785), the operative note must clearly document:

• Laterality — right, left, or bilateral
• Ureteral anatomy — single ureter (not duplicated) — rules out 50782
• Specific technique — Cohen, Politano-Leadbetter, Glenn-Anderson, Lich-Gregoir, or other
• Approach — open, laparoscopic, or robotic-assisted
• Extent of ureteral dissection and mobilization
• Whether ureteral tailoring was performed — if yes → 50783 may be more appropriate
• Whether psoas hitch or Boari flap was required — if yes → 50785 is correct code
• New ureteral orifice creation / submucosal tunnel details
• Type of anastomosis — mucosa-to-mucosa, interrupted vs. running suture, suture material
• Stent placement — type, size, duration
• Drain placement
• Estimated blood loss and urine output
• Clinical indication — VUR, stricture, congenital anomaly, oncologic, traumatic, transplant-related

⚠️ Key Documentation Differentiators:

• “Ureteral tailoring/tapering performed” → supports 50783 over 50780
• “Psoas hitch performed to bridge defect” or “Boari flap created” → supports 50785 over 50780
• “Duplicated collecting system reimplanted” → supports 50782 over 50780
• Absence of these elements in the operative note = 50780 is the appropriate code

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🔑 Key Coding Pearls

💡 Code Selection Hierarchy: Before defaulting to 50780, always ask: (1) Is the ureter duplicated? If yes → 50782. (2) Was tapering performed? If yes → 50783. (3) Was a psoas hitch or Boari flap needed? If yes → 50785. Only after ruling out all three should 50780 be selected.

💡 Robotic/Laparoscopic Approach: No separate laparoscopic CPT exists for standalone ureteroneocystostomy in the 50780 family. Report 50780 (or the appropriate family member) regardless of whether the approach was open, laparoscopic, or robotic. Document the approach in the record for facility billing purposes (robotic equipment charges apply at facility level).

💡 Transplant Scenario: If the reimplantation is performed as part of the original transplant procedure, it is bundled. If performed as a separate, later admission for post-transplant stricture or complication, 50780 is separately reportable and T86.19 is the appropriate PDX.

💡 HCC Maximization: The most impactful HCC opportunities in this patient population come from accurately capturing CKD stage (especially stage 3-5 and ESRD), transplant complications, and active malignancy. Do not allow CKD to be under-staged — the specific stage directly determines HCC category and risk score weight.

💡 Stent Integral to Procedure: A ureteral stent placed at the time of open ureteroneocystostomy is integral and not separately reported. If a stent is placed cystoscopically at a later encounter (e.g., routine stent exchange), 52332 is separately reportable.

💡 Bilateral Consideration: Bilateral VUR surgery at the same session = 50780-50. This is reimbursed at 150% of unilateral allowable under Medicare. Document bilateral anatomy and bilateral dissection clearly in the operative note.

💡 Pediatric DRG vs. Adult DRG: Many pediatric patients with VUR and congenital anomalies are insured by Medicaid managed care plans that use APR-DRG or pediatric-specific DRG systems rather than standard MS-DRGs. CC/MCC definitions and relative weights differ significantly from CMS MS-DRGs. Verify your payer’s DRG methodology for pediatric cases.

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🔗 Related Codes Quick Reference

Code	Description
50760	Ureteroureterostomy (end-to-end ureteral anastomosis)
50770	Transureteroureterostomy
50782	Ureteroneocystostomy; duplicated ureter
50783	Ureteroneocystostomy; with extensive ureteral tailoring
50785	Ureteroneocystostomy; with vesico-psoas hitch or Boari flap
50715	Ureterolysis
52332	Cystoscopy with ureteral stent placement
50360	Renal [[allotransplantation]] (transplant bundled)
38770	Pelvic lymphadenectomy (if performed concurrently for malignancy)
N13.70	Vesicoureteral-reflux, unspecified
N13.731	VUR with reflux nephropathy with hydroureter, unilateral
Q62.12	Congenital occlusion of ureterovesical orifice
Q62.2	Congenital megaureter
T86.19	Other complication of kidney transplant
N18.6	End-stage renal disease
C66.2	Malignant neoplasm of left ureter
C67.6	Malignant neoplasm of ureteric orifice

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Last reviewed: 2026-03-11 | Verify wRVU values, NCCI edits, and MS-DRG weights against current CMS Physician Fee Schedule, NCCI Policy Manual, and MS-DRG Grouper prior to billing.