Crystal's MCW Coder HubCPT 50810 — Ureterocolon Conduit, Including Intestinal Anastomosis
Overview
CPT 50810 describes the surgical creation of a ureterocolon conduit, a form of urinary diversion in which one or both ureters are surgically implanted into an isolated segment of the colon (most frequently the sigmoid or transverse colon). The isolated bowel segment functions as a passive conduit that channels urine from the upper urinary tract to the exterior of the body via a cutaneous stoma. Critically, the code descriptor specifies that it includes the intestinal anastomosis — meaning the re-establishment of bowel continuity after the conduit segment has been isolated is bundled within this single code and should not be reported separately.
This procedure is conceptually and technically distinct from the more commonly performed ileal conduit (Bricker procedure, 50820), which uses a segment of the ileum rather than the colon. The colon conduit is preferred in certain clinical scenarios, particularly when the patient has received prior pelvic radiation that has compromised ileal integrity, or when simultaneous abdominoperineal resection is being performed.
Procedure Description & Anatomy
To understand the full scope of what this code captures, it helps to walk through the operative steps:
Step 1 — Patient Positioning & Access: The patient is placed in the supine or modified lithotomy position. A midline laparotomy (or laparoscopic approach with hand-assist) provides access to the retroperitoneum and bowel.
Step 2 — Bowel Segment Isolation: A segment of the colon — frequently the sigmoid colon, but may also be the transverse colon — is isolated on its mesenteric vascular pedicle to preserve blood supply. The length of the conduit segment is typically 15-20 cm.
Step 3 — Intestinal Anastomosis (Included): Once the conduit segment is harvested, the remaining bowel ends are re-anastomosed to restore GI continuity. This anastomosis (whether stapled or hand-sewn) is included in 50810 and is not separately reportable.
Step 4 — Ureteral Implantation: The ureters are mobilized, and ureteral-colonic anastomoses are performed — either as an end-to-side implantation or through a tunneled anti-reflux technique (Wallace or Bricker-type anastomosis adapted for colon).
Step 5 — Stoma Creation: The distal end of the colon segment is matured as a cutaneous stoma, typically in the left lower quadrant.
Code Details at a Glance
| Field | Detail |
|---|---|
| CPT Code | 50810 |
| Full Descriptor | Ureterocolon conduit, including intestinal anastomosis |
| Code Family | Urinary Diversion (50800-50830) |
| Global Period | 090 days (Major Surgery) |
| wRVU | ~26.28 (verify against current MPFS annually) |
| Assistant Payable | Yes |
| Bilateral Indicator | Unilateral by nature; modifier -50 not applicable |
| Facility vs. Non-Facility | Facility only (hospital/ASC) |
| Anesthesia | General endotracheal |
Note on wRVU:
Work RVU values are published annually in the Medicare Physician Fee Schedule (MPFS) and are subject to revision. Always verify against the current calendar year MPFS before using for productivity reporting or contract negotiations.
Assistant Surgeon Payable
Yes, assistant surgeon services are payable for 50810. This is a major intra-abdominal procedure involving bowel mobilization, multiple anastomoses, and ureteral dissection. The complexity and technical demands of this operation routinely justify and require the presence of an assistant surgeon. The assistant would typically report 50810 appended with modifier -80 (Assistant Surgeon) or -82 (Assistant Surgeon when qualified resident not available), depending on the setting.
Includes (Bundled — Do Not Report Separately)
The following services are considered integral components of 50810 and are not separately reportable on the same date of service:
- Intestinal anastomosis — Explicitly stated in the code descriptor. The reanastomosis of bowel ends after conduit harvest is bundled.
- Mobilization of the ureters — Routine ureteral dissection necessary to reach the conduit is included.
- Stoma creation — The maturation of the colostomy/urostomy stoma is part of completing the diversion.
- Closure of the abdominal wall — Routine fascial and skin closure.
- Intraoperative ureteral stent placement — When placed as part of the anastomosis for calibration or short-term drainage, this is typically considered incidental.
Excludes / Separately Reportable Considerations
The following are generally not bundled and may be separately reportable when performed as distinct, additional procedures with documented medical necessity:
- 50840 — Replacement of all or part of ureter by intestine: if ureteral replacement (as opposed to simple diversion) is the primary intent, this may be more appropriate.
- 44139 — Mobilization of splenic flexure: if extensive splenic flexure takedown is required and separately documented, this may be reportable with modifier -59 or an X-modifier, depending on payer policy.
- 49000 — Exploratory laparotomy: only separately reportable if a separate, distinct exploratory procedure precedes a planned operation. Do not routinely report in addition to 50810.
- Cystectomy — When 50810 is performed in the context of a radical or simple cystectomy, the cystectomy is reported separately (e.g., 51570, 51575, 51580, 51585, 51590, 51595, 51596). This is a common combined operative scenario, and both codes are appropriately reported.
- Lymph node dissection — Pelvic lymphadenectomy performed as part of a concurrent radical cystectomy is reported separately (e.g., 38770).
- Ureteral stenting (long-term) — If a separately placed, long-term ureteral stent is placed as a distinct service from the anastomosis, consider 50605 or 52332 depending on approach.
CPT Code Tree — Urinary Diversion Family (50800-50830)
Understanding where 50810 sits within its family helps you select the right code and understand the clinical distinctions that drive code selection.
50800 — Ureteroenterostomy, direct anastomosis of ureter to intestine: This is the “parent” concept — direct implantation of ureter into bowel without creating a conduit segment. Less commonly reported as a standalone procedure in modern practice.
50810 — Ureterocolon conduit, including intestinal anastomosis: The subject of this note. Colon-based passive conduit with cutaneous stoma.
50815 — Ureterocolic conduit: Variant involving implantation into the colon with rectal drainage (wet colostomy or ureterosigmoidostomy type). Distinguish carefully from 50810; 50815 does not necessarily involve a cutaneous stoma.
50820 — Ureteroileal conduit (Bricker procedure), including anastomosis of ileum: The most commonly performed urinary diversion in the United States. Uses ileum rather than colon. Requires same level of intestinal anastomosis documentation.
50825 — Continent diversion, including intestinal anastomosis using any segment of small and/or large intestine: Used for Indiana pouch, Koch pouch, or neobladder-type diversions where the patient has volitional control over voiding via catheterizable stoma or orthotopic neobladder. This is a distinctly more complex reconstruction than 50810.
50830 — Urinary undiversion (e.g., taking down of ureteroileal conduit, ureterosigmoidostomy, or ureterocutaneostomy with ureteroneocystostomy or ureteroureterostomy): Used when reversing a prior urinary diversion.
ICD-10-CM Diagnoses Commonly Associated with 50810
Because this procedure is almost always performed in conjunction with cystectomy or as a result of severe lower urinary tract pathology, the following ICD-10-CM codes represent the most clinically and coding-relevant diagnoses. HCC assignments are based on the CMS-HCC Risk Adjustment Model (v24/v28); always verify current model year mappings, as HCC assignments are subject to annual revision.
Malignant Neoplasms of the Bladder
These are the most common indications for urinary diversion via colon conduit.
C67.0 — Malignant neoplasm of trigone of urinary bladder C67.1 — Malignant neoplasm of dome of urinary bladder C67.2 — Malignant neoplasm of lateral wall of urinary bladder C67.3 — Malignant neoplasm of anterior wall of urinary bladder C67.4 — Malignant neoplasm of posterior wall of urinary bladder C67.5 — Malignant neoplasm of bladder neck C67.6 — Malignant neoplasm of ureteric orifice C67.8 — Malignant neoplasm of overlapping lesion of bladder C67.9 — Malignant neoplasm of bladder, unspecified
HCC Assignment (Bladder Cancer): Under CMS-HCC v24, bladder malignancies map to HCC 12 (Lung and Other Severe Cancers). Under the revised v28 model, verify current mapping as the cancer HCC groupings were restructured. HCC 12 in v24 carries significant risk weight, reflecting the high resource utilization and comorbidity burden associated with invasive bladder cancer. This HCC assignment is relevant for risk-adjusted payment models and should be captured on all inpatient encounters.
Malignant Neoplasm of the Ureter
C66.1 — Malignant neoplasm of right ureter C66.2 — Malignant neoplasm of left ureter C66.9 — Malignant neoplasm of ureter, unspecified
HCC Assignment: C66.x also maps to HCC 12 (v24). Upper tract urothelial carcinoma involving the ureter may necessitate nephroureterectomy combined with urinary diversion when bilateral disease or compromised bladder function is present.
Malignant Neoplasm of the Renal Pelvis
C65.1 — Malignant neoplasm of right renal pelvis C65.2 — Malignant neoplasm of left renal pelvis C65.9 — Malignant neoplasm of renal pelvis, unspecified
HCC Assignment: C65.x maps to HCC 12 (v24).
Pelvic Malignancies Requiring Diversion as Part of Exenteration
C53.9 — Malignant neoplasm of cervix uteri, unspecified C20 — Malignant neoplasm of rectum
HCC Assignment: C53.9 maps to HCC 11 (Colorectal, Bladder, Ureter, and Renal Pelvis Cancers) or HCC 12 depending on model version. C20 maps to HCC 12 (v24). These codes are relevant when 50810 is performed as part of a pelvic exenteration where bladder involvement necessitates urinary diversion.
Non-Malignant Indications
N32.1 — Vesicointestinal fistula
Complex fistulous disease between the bladder and bowel, often from Crohn’s disease, diverticular disease, or prior radiation, may necessitate urinary diversion. No HCC assignment.
N32.89 — Other specified disorders of bladder
Used when bladder dysfunction is severe but doesn’t fit a more specific category. No HCC assignment.
Q64.10 — Exstrophy of urinary bladder, unspecified Q64.19 — Other exstrophy of urinary bladder
Congenital exstrophy may ultimately require urinary diversion when primary reconstruction fails or is not feasible. No HCC assignment.
N30.10 — Interstitial cystitis (chronic) without hematuria N30.11 — Interstitial cystitis (chronic) with hematuria
End-stage interstitial cystitis refractory to all conservative and intermediate therapies is a rare but recognized indication. No HCC assignment.
N39.3 — Stress incontinence (female) (male) — less common but may be relevant in complex reconstruction scenarios
No HCC assignment.
T85.510A / T85.511A — Breakdown/displacement of implanted urinary sphincter — relevant in revision scenarios
No HCC assignment.
MS-DRG Assignment
When CPT 50810 is the principal operative procedure (or performed in conjunction with cystectomy), the MS-DRG assignment is driven by the principal diagnosis and the presence of major complications or comorbidities (MCC) or complications/comorbidities (CC).
Primary DRG Family — Other Kidney & Urinary Tract Procedures:
| MS-DRG | Description | Relative Weight (approx.) |
|---|---|---|
| 673 | Other Kidney & Urinary Tract Procedures with MCC | ~4.5-5.2 |
| 674 | Other Kidney & Urinary Tract Procedures with CC | ~2.8-3.2 |
| 675 | Other Kidney & Urinary Tract Procedures without CC/MCC | ~1.8-2.2 |
Important: When 50810 is performed alongside a cystectomy (very common clinical scenario), the cystectomy CPT code (e.g., 51590, 51595, 51596) will typically be the OR-defining procedure, and the MS-DRG may shift to the Kidney & Urinary Tract Neoplasm or Major Bladder Procedures DRG families. The two most relevant in that context are:
| MS-DRG | Description |
|---|---|
| 303 | Kidney, Ureter & Major Bladder Procedures for Neoplasm with MCC |
| 304 | Kidney, Ureter & Major Bladder Procedures for Neoplasm with CC |
| 305 | Kidney, Ureter & Major Bladder Procedures for Neoplasm without CC/MCC |
Always verify that the principal procedure’s OR procedure status drives the correct DRG logic in your grouper. Both 50810 and the concurrent cystectomy code carry OR procedure status and will both affect the DRG calculation.
Coding Examples
Example 1 — Muscle-Invasive Bladder Cancer, Radical Cystectomy with Colon Conduit
Clinical Scenario: A 68-year-old male with T2 high-grade urothelial carcinoma of the bladder undergoes radical cystoprostatectomy with creation of a ureterocolon conduit and pelvic lymph node dissection. The bowel is reanastomosed after harvest of the sigmoid segment.
ICD-10-CM Principal Diagnosis: C67.9 — Malignant neoplasm of bladder, unspecified (or specify site if documented, e.g., C67.2) Secondary Dx: Z79.899 — Other long-term drug therapy (if applicable), relevant comorbidities
CPT Codes:
- 51590 — Cystectomy, complete, with ureteroileal conduit (Note: if combined with diversion, some payers prefer 51595 or 51596 — review descriptor carefully)
- 50810 — Ureterocolon conduit, including intestinal anastomosis
- 38770 — Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes
MS-DRG: 303, 304, or 305 depending on CC/MCC burden
Example 2 — End-Stage Bladder Disease from Radiation, Urinary Diversion Only
Clinical Scenario: A 72-year-old female with radiation cystitis and contracted bladder following treatment for cervical cancer. Ileum is not usable due to radiation damage. Patient undergoes ureterocolon conduit diversion only (no cystectomy).
ICD-10-CM Principal Diagnosis: N30.40* — Irradiation cystitis without hematuria (or N30.41 with hematuria) Secondary Dx: C53.9* — History of cervical cancer (use Z85.41 if in remission); Y84.2 — Radiological procedure as cause of abnormal reaction
CPT Codes:
- 50810 — Ureterocolon conduit, including intestinal anastomosis
MS-DRG: 673, 674, or 675 depending on CC/MCC burden
Example 3 — Pelvic Exenteration with Concurrent Urinary Diversion
Clinical Scenario: A 61-year-old female with recurrent cervical carcinoma invading the bladder. She undergoes total pelvic exenteration (anterior and posterior) with ureterocolon conduit creation and end colostomy.
ICD-10-CM Principal Diagnosis: C53.8 — Malignant neoplasm of overlapping lesion of cervix uteri Secondary Dx: Secondary involvement of bladder — C67.9
CPT Codes:
- 45126 — Pelvic exenteration for colorectal malignancy, with colostomy and/or ileostomy, with or without bladder excision, when performed
- 50810 — Ureterocolon conduit (separately reportable with appropriate modifier if bundling edits apply; review NCCI)
- Check NCCI edits carefully — pelvic exenteration bundles may affect separate billing of 50810
Clinical & Coding Pearls
It’s worth pausing to emphasize a few subtleties that trip up even experienced urological coders working with this code family.
Colon vs. Ileum is the key differentiator. The single most important distinction in this code family is which segment of bowel is used for the conduit. If the surgeon uses the ileum, the correct code is 50820, not 50810. If documentation is ambiguous, query the surgeon. Never assume.
“Including intestinal anastomosis” means do not separately report the bowel anastomosis. This is explicitly bundled. Reporting 44130 or 44145 in addition to 50810 for the same session will trigger an NCCI edit and a denial.
Continent diversions are categorically different. If the documentation describes a Koch pouch, Indiana pouch, or orthotopic neobladder, the correct code is 50825, not 50810. The presence of a catheterizable or continent mechanism fundamentally changes the code selection.
When cystectomy accompanies diversion, both codes are appropriate. This is one of the more common combined procedures in urology, and both the cystectomy and the diversion code should be reported. Review payer-specific policies for any bundling guidelines, and append modifier -51 (Multiple Procedures) to the secondary procedure per standard CPT convention, unless the payer uses relative value-based payment where -51 may be waived.
Document the indication clearly. The HCC risk-adjustment value of the bladder malignancy diagnoses associated with this procedure (HCC 12) is substantial. Ensuring the principal diagnosis is coded to the highest level of specificity — specific bladder wall site, laterality for ureteral primaries, histological type when available — maximizes appropriate risk capture and reduces audit vulnerability.
Query for prior radiation history. When the operative note mentions selecting colon over ileum due to radiation damage to the small bowel, ensure that radiation cystitis or radiation enteritis is captured as a secondary diagnosis, as it may carry CC/MCC weight and affect DRG assignment.
Related CPT Codes (Quick Reference)
| Code | Description |
|---|---|
| 50800 | Ureteroenterostomy, direct anastomosis |
| 50810 | Ureterocolon conduit, w/ intestinal anastomosis (this note) |
| 50815 | Ureterocolic conduit |
| 50820 | Ureteroileal conduit (Bricker), w/ intestinal anastomosis |
| 50825 | Continent diversion, w/ intestinal anastomosis |
| 50830 | Urinary undiversion |
| 51590 | Cystectomy, complete, with ureteroileal conduit |
| 51595 | Cystectomy, complete, with continent diversion |
| 51596 | Cystectomy, complete, with continent bladder |
| 38770 | Pelvic lymphadenectomy |
| 44139 | Mobilization of splenic flexure (if separately documented) |
FYI: The wRVU of ~26.28 should be treated as a reference estimate — the MPFS updates annually, and major surgical codes in the urinary diversion family can shift modestly year to year. It’s always worth a quick MPFS lookup before citing it in productivity conversations.
Last reviewed: 2026-03-11 | Verify wRVU and MS-DRG weights against current-year CMS data