50860

🌿 CPT 50860 - Ureterostomy, with Transplantation of Ureter into Skin (Cutaneous Ureterostomy)

Full Descriptor: Ureterostomy, with transplantation of ureter into skin

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🧭 At a Glance

Field	Detail
CPT Code	50860
Code Family	Surgery / Urinary System
Section	50700-50980 (Ureter)
Laterality	Unilateral per descriptor; bilateral requires modifier -50 or two line items with -LT/-RT
wRVU	~12.67 (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 or regional
NCCI Edits	Multiple — see bundling section below

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📖 Detailed Description

CPT 50860 describes the surgical creation of a cutaneous ureterostomy — a form of urinary diversion in which one or both ureters are surgically mobilized from their native anatomical course and brought directly through the abdominal wall to the skin surface, where they are matured as a permanent stoma. This allows urine to drain continuously from the kidney into an external collection appliance, bypassing the bladder entirely.

Unlike continent urinary diversions (e.g., Indiana pouch, neobladder) or intestinal conduit diversions (e.g., ileal conduit — 50820), cutaneous ureterostomy requires no bowel segment interposition, making it a significantly lower-risk and technically simpler diversion option. This is its primary advantage in the appropriate clinical context.

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Anatomical and Physiological Context

Under normal circumstances, the ureter travels retroperitoneally from the renal pelvis to the posterolateral bladder wall. In cutaneous ureterostomy:

1. The ureter (right, left, or both) is dissected free from its retroperitoneal attachments
2. Sufficient length is mobilized to reach the anterior abdominal wall without tension
3. A skin opening (stoma site) is fashioned, typically in the right or left lower quadrant
4. The ureteral end is brought through the abdominal wall musculature and subcutaneous tissue
5. The ureteral end is everted and sutured to the skin (matured) to create a flush or slightly budded stoma
6. A ureteral stent or feeding tube may be placed transstomal to maintain patency during healing

When bilateral cutaneous ureterostomy is performed, both ureters may be:

• Brought out as two separate stomas (double-barrel or side-by-side)
• Transposed and joined to a single skin opening (transureteroureterostomy combined with single cutaneous ureterostomy — a distinct procedure requiring additional coding consideration)

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Clinical Indications

Cutaneous ureterostomy is typically reserved for patients in whom more complex reconstructive or intestinal diversion procedures are not feasible or safe. Common clinical scenarios include:

• Bladder cancer requiring cystectomy in a patient who is not a candidate for ileal conduit or neobladder due to poor bowel function, extensive prior abdominal surgery, or frail/high-operative-risk status
• Neurogenic bladder with intractable urinary incontinence or obstruction (especially in pediatric spina bifida patients where a loop or ring cutaneous ureterostomy is used as a temporary measure)
• Malignant ureteral obstruction — palliation for unresectable pelvic malignancies causing bilateral ureteral obstruction when nephrostomy tubes have failed or are not tolerated
• Bladder dysfunction refractory to all conservative management (end-stage radiation cystitis, contracted bladder)
• Congenital anomalies — pediatric patients with massively dilated ureters (megaureters, posterior urethral valves, prune belly syndrome) where a cutaneous loop ureterostomy can serve as temporary high diversion to protect the upper tracts while the child grows to a size suitable for definitive reconstruction
• Emergency/salvage diversion when a more complex procedure is too risky in an acutely ill patient
• Ureteral trauma with extensive lower ureteral loss and a patient too unstable for reconstruction

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Types of Cutaneous Ureterostomy Captured by 50860

All of the following techniques are encompassed within 50860, as long as a single ureter is involved per unit billed:

End Cutaneous Ureterostomy

• The distal ureter is transected and the proximal ureteral end is brought to the skin
• The native bladder remains but is defunctionalized
• Used in permanent diversion scenarios
• Stomal stenosis is the most common long-term complication due to the small caliber of the ureter

Loop (High) Cutaneous Ureterostomy

• A loop of ureter (rather than the end) is externalized through the abdominal wall
• The loop is opened and both limbs are matured to the skin
• Preserves continuity of the ureter for potential future takedown
• Primarily used as temporary pediatric diversion (e.g., in prune belly syndrome, high-grade obstruction with poor renal function)

Ring Ureterostomy

• A small segment of the dilated ureter is exteriorized through a separate skin incision
• The stoma is fashioned as a ring of ureteral wall sutured to the skin
• Used in massively dilated megaureters in infants

📝 Temporary vs. Permanent: 50860 covers both temporary (pediatric loop ureterostomy with planned takedown) and permanent diversion. The distinction affects clinical documentation and long-term management but does not alter CPT code selection.

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✅ Includes

• Retroperitoneal ureteral dissection and mobilization
• Division/transection of the ureter at the appropriate level (if end ureterostomy)
• Creation of the abdominal wall stoma site (fascial incision, subcutaneous tunnel)
• Maturation of the ureteral stoma to skin
• Stent or catheter placement through the stoma at time of surgery (if performed — generally considered integral)
• Wound closure
• Bilateral procedure may be reported with modifier -50 for two-sided simultaneous ureterostomies
• Loop ureterostomy creation including the enterotomy/ureterotomy to open the loop

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❌ Excludes / Parenthetical Notes

Excluded/Separate Service	Code	Notes
Cutaneous uretero-enterostomy (intestinal conduit — ileal conduit)	50820	Entirely distinct procedure using bowel segment as conduit to skin; not a direct ureteral anastomosis to skin
Ureterosigmoidostomy	50810	Ureter anastomosed to sigmoid colon
Transureteroureterostomy followed by single cutaneous ureterostomy	50770 + 50860	If one ureter is anastomosed to the other (TUU) and then the cross-anastomosed ureter is brought to skin, both codes may apply — verify NCCI and document distinctly
Nephrostomy tube placement	50040	Percutaneous nephrostomy — a distinct, less invasive drainage procedure
Ureteroneocystostomy (reimplantation into bladder)	50780-50785	Reconnection to bladder is fundamentally different from skin diversion
Radical cystectomy (if performed at same session)	51570-51596	Cystectomy + cutaneous ureterostomy may be reported together — verify NCCI edits; see bundling discussion
Ileal conduit or continent diversion (if bowel used)	50820, 50825	If bowel segment is interposed, these codes apply instead
Stoma revision (subsequent encounter)	50860 is not appropriate for simple stoma revision — see 50727, 50728	Stomal revision/refashioning is a distinct later service
Closure/takedown of cutaneous ureterostomy	50830	Urinary undiversion — separate and later procedure
Retroperitoneal lymphadenectomy if performed concurrently	38770, 38780	May be separately reported with appropriate modifier if distinct and not bundled
Ureteral stent exchange via stoma (subsequent encounter)	52332	Stent exchanges after the global period are separately reportable

⚠️ NCCI Bundling Alert: When 50860 is reported alongside radical cystectomy codes (51570-51596), NCCI edits may bundle the ureterostomy into the cystectomy. Always verify active NCCI edits. If the pelvic lymphadenectomy (38770) is also performed at the same session, it may similarly be bundled depending on the cystectomy code used. Run NCCI checks before billing any combination with cystectomy.

⚠️ 50820 vs. 50860 — Critical Distinction: This is one of the most common code selection errors in urinary diversion coding. 50820 (ileal conduit) requires harvest and interposition of a bowel segment. 50860 is a direct ureter-to-skin anastomosis with no bowel involvement. The operative note must be read carefully to identify whether bowel was used. If there is any mention of ileum, colon, or bowel isolation in the operative note, 50820 or 50810 is likely more appropriate.

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🔗 Code Tree — Urinary Diversion & Ureter-to-Skin/Bowel Family

Surgery → Urinary System → Ureter (50700-50980)
│
├── Ureterotomy / Drainage
│   ├── 50040 — Nephrostomy; nephrotomy, with drainage
│   ├── 50045 — Nephrotomy; with exploration
│   └── 50125 — Nephrostomy; with drainage (separate procedure)
│
├── Ureteral Anastomosis / Diversion
│   ├── 50760 — Ureteroureterostomy
│   ├── 50770 — Transureteroureterostomy
│   ├── 50780-50785 — Ureteroneocystostomy family (bladder reimplantation)
│   ├── 50800 — Ureterotomy (enterostomy — ureteral anastomosis to intestinal segment)
│   │
│   ├── 🔵 URINARY DIVERSION AXIS
│   │   ├── 50810 — Ureterosigmoidostomy
│   │   ├── ⭐ 50860 — Ureterostomy with transplantation of ureter into SKIN
│   │   │               (Cutaneous Ureterostomy — direct, no bowel)
│   │   ├── 50820 — Ureteroileal conduit (ileal conduit — with bowel segment)
│   │   ├── 50825 — Continent diversion (Indiana pouch, Koch pouch, etc.)
│   │   └── 50830 — Urinary undiversion (takedown/reversal of prior diversion)
│   │
│   └── 50840 — Replacement of all or part of ureter by intestinal segment
│
└── Stoma Revision
    ├── 50727 — Revision of urinary anastomosis with repair of stricture
    └── 50728 — Revision of urinary anastomosis with repair of stricture; with repair of ventral hernia

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🏥 Common ICD-10-CM Diagnoses Paired with 50860

🔴 Malignant Neoplasms — Most Common Adult Indication

ICD-10-CM Code	Description	HCC	HCC Weight (v28 approx.)
C67.9	Malignant neoplasm of bladder, unspecified	HCC 11	0.321
C67.0	Malignant neoplasm of trigone of bladder	HCC 11	0.321
C67.1	Malignant neoplasm of dome of bladder	HCC 11	0.321
C67.2	Malignant neoplasm of lateral wall of bladder	HCC 11	0.321
C67.3	Malignant neoplasm of anterior wall of bladder	HCC 11	0.321
C67.4	Malignant neoplasm of posterior wall of bladder	HCC 11	0.321
C67.5	Malignant neoplasm of bladder neck	HCC 11	0.321
C67.6	Malignant neoplasm of ureteric orifice	HCC 11	0.321
C67.8	Malignant neoplasm of overlapping sites of bladder	HCC 11	0.321
C66.1	Malignant neoplasm of right ureter	HCC 11	0.321
C66.2	Malignant neoplasm of left ureter	HCC 11	0.321
C66.9	Malignant neoplasm of ureter, unspecified	HCC 11	0.321
C61	Malignant neoplasm of prostate (ureteral obstruction by extension)	HCC 12	0.327
C53.9	Malignant neoplasm of cervix uteri, unspecified	HCC 11	0.321
C54.1	Malignant neoplasm of endometrium	HCC 11	0.321
C55	Malignant neoplasm of uterus, part unspecified	HCC 11	0.321
C56.9	Malignant neoplasm of unspecified ovary	HCC 11	0.321
C20	Malignant neoplasm of rectum (pelvic tumor with bilateral ureteral obstruction)	HCC 11	0.321

💡 HCC Note: Bladder cancer (C67.x) and ureteral malignancies (C66.x) map to HCC 11 under CMS HCC v28. Prostate malignancy maps to HCC 12. When cutaneous ureterostomy is performed for palliation of malignant obstruction, both the primary malignancy and secondary codes such as C77.5 (secondary intrapelvic lymph nodes, if documented) should be reported. Confirm active vs. historical malignancy status — an active malignancy codes significantly differently from a personal history code and carries substantially more HCC weight.

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🟠 Malignant Ureteral Obstruction / Secondary Malignancy

ICD-10-CM Code	Description	HCC	Notes
C77.5	Secondary malignant neoplasm of intrapelvic lymph nodes	HCC 8	Nodal compression of ureters
C79.19	Secondary malignant neoplasm of other urinary organs	HCC 8
C79.89	Secondary malignant neoplasm of other specified sites	HCC 8	Periureteral metastatic disease
N13.1	Hydronephrosis with ureteral stricture NEC	❌ None	May be used concurrently if structural stricture documented separately from malignancy
N13.30	Hydronephrosis, unspecified	❌ None	Secondary to obstruction

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🟡 Neurogenic Bladder / Bladder Dysfunction — Significant Indication, Especially Pediatric

ICD-10-CM Code	Description	HCC	Notes
N31.9	Neuromuscular dysfunction of bladder, unspecified	❌ None	Nonspecific
N31.0	Uninhibited neuropathic bladder, NEC	❌ None
N31.1	Reflex neuropathic bladder, NEC	❌ None
N31.2	Flaccid neuropathic bladder, NEC	❌ None	Common in spina bifida
N31.8	Other neuromuscular dysfunction of bladder	❌ None
G95.89	Other specified diseases of spinal cord	❌ None	Myelomeningocele-related dysfunction
Q05.0	Cervical spina bifida with hydrocephalus	❌ None	Pediatric — congenital
Q05.1	Thoracic spina bifida with hydrocephalus	❌ None
Q05.2	Lumbar spina bifida with hydrocephalus	❌ None	Most common level for neurogenic bladder
Q05.3	Sacral spina bifida with hydrocephalus	❌ None
Q05.5	Cervical spina bifida without hydrocephalus	❌ None
Q05.7	Lumbar spina bifida without hydrocephalus	❌ None
G82.20	Paraplegia, unspecified	❌ None	Spinal cord injury with neurogenic bladder
G82.50	Quadriplegia, unspecified	❌ None

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🟢 Congenital Anomalies of Urinary Tract — Pediatric Population

ICD-10-CM Code	Description	HCC	Notes
Q64.10	Exstrophy of urinary bladder, unspecified	❌ None	Severe bladder anomaly requiring diversion
Q64.11	Supravesical fissure of urinary bladder	❌ None
Q64.12	Cloacal exstrophy of urinary bladder	❌ None
Q64.19	Other exstrophy of urinary bladder	❌ None
Q64.31	Congenital bladder neck obstruction	❌ None
Q64.39	Other atresia and stenosis of urethra and bladder neck	❌ None
Q62.2	Congenital megaureter	❌ None	Massively dilated ureter; loop ureterostomy common
Q62.0	Congenital hydronephrosis	❌ None
Q64.4	Malformation of urachus	❌ None
Q79.4	Prune belly syndrome	❌ None	Eagle-Barrett syndrome; bilateral ureteral dilation common indication for loop ureterostomy
Q64.2	Congenital posterior urethral valves	❌ None	Obstruction causing upper tract deterioration; temporary ureterostomy may be employed

💡 Pediatric Coding Note: Congenital anomalies such as prune belly syndrome (Q79.4) and posterior urethral valves (Q64.2) are among the most important indications for temporary loop cutaneous ureterostomy in the pediatric population. These codes carry no HCC weight themselves, but the downstream CKD they cause does. Assign CKD stage codes when documented (N18.1-N18.6) — these carry significant HCC and DRG impact.

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🔵 Radiation Injury / Fistula / End-Stage Bladder Disease

ICD-10-CM Code	Description	HCC	Notes
N30.40	Irradiation cystitis without hematuria	❌ None	Radiation-damaged contracted bladder
N30.41	Irradiation cystitis with hematuria	❌ None
N32.1	Vesicointestinal fistula	❌ None	Complex fistula requiring diversion
N32.2	Vesical fistula, NEC	❌ None
N32.0	Bladder neck obstruction	❌ None
N32.89	Other specified disorders of bladder	❌ None	End-stage contracted/fibrotic bladder
L89.x	Pressure ulcer codes	❌ None	Urine diversion to manage wound healing in paraplegic patients
T85.511A	Breakdown of urinary catheter, initial encounter	❌ None	Failed chronic catheterization
N39.3	Stress incontinence (female)	❌ None
N39.41	Urge incontinence	❌ None	End-stage refractory incontinence
N39.498	Other specified urinary incontinence	❌ None

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🟣 Renal Failure & CKD — Frequently Co-Reported

ICD-10-CM Code	Description	HCC	Notes
N17.9	Acute kidney injury, unspecified	HCC 135	Obstructive AKI — may precipitate urgent diversion
N18.1	Chronic kidney disease, stage 1	❌ None
N18.2	Chronic kidney disease, stage 2	❌ None
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
N18.4	Chronic kidney disease, stage 4	HCC 138
N18.5	Chronic kidney disease, stage 5	HCC 138
N18.6	End-stage renal disease	HCC 136	Most severe HCC in renal category

⚠️ HCC Sequencing and Capture: Cutaneous ureterostomy patients frequently have multi-system disease. CKD (N18.3—N18.6) maps to some of the highest-weighted HCC categories. Do not leave CKD undocumented or under-staged. Acute kidney injury (N17.9) maps to HCC 135 and is common in the setting of acute obstructive uropathy presenting for emergency diversion. When the patient has CKD with an acute obstructive component, both may be coded per provider documentation.

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🏨 MS-DRG Mapping

CPT 50860 is an OR procedure that will drive surgical MS-DRG assignment. The principal diagnosis determines the specific DRG triple, refined by CC/MCC status.

Non-Neoplastic Diagnoses (Neurogenic Bladder, Congenital Anomalies, Obstruction, Radiation Injury)

MS-DRG	Description	GMLOS (approx.)
661	Kidney and Ureter Procedures for Non-Neoplasm with MCC	~7.1 days
662	Kidney and Ureter Procedures for Non-Neoplasm with CC	~3.8 days
663	Kidney and Ureter Procedures for Non-Neoplasm without CC/MCC	~2.4 days

Neoplastic Diagnoses (Bladder, Ureteral, Pelvic Malignancies)

MS-DRG	Description	GMLOS (approx.)
671	Kidney and Ureter Procedures for Neoplasm with MCC	~9.5 days
672	Kidney and Ureter Procedures for Neoplasm with CC	~5.0 days
673	Kidney and Ureter Procedures for Neoplasm without CC/MCC	~3.1 days

When Performed Concurrently with Radical Cystectomy

MS-DRG	Description	Notes
673	Kidney and Ureter Procedures for Neoplasm, no CC/MCC	Cystectomy + ureterostomy; DRG driven by principal diagnosis + OR procedure
671	Kidney and Ureter Procedures for Neoplasm with MCC	With MCC (e.g., ESRD, respiratory failure, sepsis)
672	Kidney and Ureter Procedures for Neoplasm with CC	With CC (e.g., CKD stage 3-4, UTI, DVT)

💡 MS-DRG Tip — Concurrent Cystectomy: When a radical cystectomy (51570-51596) is performed at the same admission along with bilateral cutaneous ureterostomies, the cystectomy codes may dominate MS-DRG assignment. However, note that cutaneous ureterostomy (as opposed to an ileal conduit 50820) may affect DRG assignment differently. Verify your facility’s DRG grouper behavior with both the cystectomy and 50860 submitted together.

CC/MCC Opportunities in This Patient Population

Frequent MCCs:

• Acute kidney injury (N17.9) — HCC 135, qualifies as MCC
• Sepsis/urosepsis (A41.9 etc.) — MCC
• ESRD (N18.6) — HCC 136, qualifies as MCC
• Respiratory failure — MCC
• Malignant ascites, peritoneal carcinomatosis — MCC

Frequent CCs:

• CKD stage 3-4 (N18.3—N18.4) — HCC 138, CC
• UTI (N39.0) — CC
• Ileus (K56.7) — CC
• DVT (I82.401) — CC
• Hypoalbuminemia (E88.09) — CC
• Malnutrition (E43, E44.0) — CC or MCC depending on severity
• Neurogenic bladder (N31.x) — CC when due to documented underlying neurological disease

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💉 ICD-10-PCS Procedure Codes (Inpatient)

For inpatient encounters, 50860 maps to ICD-10-PCS in the Urinary System (T) body system, Medical and Surgical (0) section. The most appropriate root operation is Bypass (1) — rerouting the contents of the ureter to an external stoma, or in some contexts Diversion.

ICD-10-PCS Code	Description
0T160ZA	Bypass right ureter to cutaneous, open approach
0T170ZA	Bypass left ureter to cutaneous, open approach
0T1B0ZA	Bypass bilateral ureters to cutaneous, open approach
0T164ZA	Bypass right ureter to cutaneous, percutaneous endoscopic (laparoscopic)
0T174ZA	Bypass left ureter to cutaneous, percutaneous endoscopic
0T1B4ZA	Bypass bilateral ureters to cutaneous, percutaneous endoscopic

📝 PCS Root Operation Note: The root operation Bypass (1) is defined in ICD-10-PCS as “altering the route of passage of the contents of a tubular body part.” This applies directly to ureterostomy — the urine that would normally pass to the bladder is rerouted to the exterior skin surface. The qualifier “Cutaneous” (A) is used to designate the skin as the destination body part. If a loop ureterostomy is performed and later taken down, the PCS code for the takedown/closure would use root operation Repair (Q) or Reposition (S) depending on what is done at takedown.

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🧪 Coding Examples

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✏️ Example 1 — Muscle-Invasive Bladder Cancer, Radical Cystectomy with Bilateral Cutaneous Ureterostomies (Inpatient)

Clinical Scenario: A 78-year-old male with muscle-invasive urothelial carcinoma of the posterior wall of the bladder (C67.4) is deemed a poor candidate for ileal conduit diversion due to extensive prior abdominal radiation and compromised bowel function. He undergoes open radical cystectomy with creation of bilateral end cutaneous ureterostomies (right and left) brought out through separate stoma sites in the bilateral lower quadrants. He has CKD stage 3b (N18.32) and hypertension (I10). No lymphadenectomy performed due to performance status.

CPT Reported:

• 51570 — Cystectomy, complete (separate from urinary diversion)
• 50860-50 — Bilateral cutaneous ureterostomy (verify NCCI bundling with 51570; if bundled, modifier -59 with documentation may apply, or review payer-specific guidance)

ICD-10-CM (Inpatient Sequencing):

1. C67.4 — Malignant neoplasm of posterior wall of bladder (PDX) — HCC 11
2. N18.32 — Chronic kidney disease, stage 3b (CC) — HCC 138
3. I10 — Essential hypertension

ICD-10-PCS:

• Resection of bladder, open (cystectomy)
• 0T1B0ZA — Bypass bilateral ureters to cutaneous, open approach

MS-DRG:

• CKD stage 3b qualifies as CC → MS-DRG 672 (Kidney and Ureter Procedures for Neoplasm with CC)

⚠️ Operative Note Review Requirement: Confirm the operative note explicitly states no bowel segment was used. Any mention of bowel harvesting would point to 50820 (ileal conduit) rather than 50860. This distinction is critical — a miscode here would represent a significant upcoding or downcoding error depending on direction.

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✏️ Example 2 — Pediatric Prune Belly Syndrome, Bilateral Loop Cutaneous Ureterostomies (Temporary, Inpatient)

Clinical Scenario: A 6-week-old male with Eagle-Barrett (prune belly) syndrome (Q79.4) presents with massively dilated bilateral megaureters and deteriorating renal function. He undergoes bilateral loop cutaneous ureterostomies as a temporary measure to decompress the upper tracts while he grows to an appropriate size for definitive reconstruction. Concurrent diagnoses include congenital megaureter (Q62.2) and stage 4 CKD (N18.4).

CPT Reported:

• 50860-50 — Bilateral loop cutaneous ureterostomies (both sides performed simultaneously)

ICD-10-CM (Inpatient Sequencing):

1. Q79.4 — Prune belly syndrome (PDX)
2. Q62.2 — Congenital megaureter (additional specificity — bilateral)
3. N18.4 — Chronic kidney disease, stage 4 (CC) — HCC 138

ICD-10-PCS:

• 0T1B0ZA — Bypass bilateral ureters to cutaneous, open approach

MS-DRG:

• CKD stage 4 qualifies as CC → MS-DRG 662 (Kidney and Ureter Procedures for Non-Neoplasm with CC)

Notes: The procedure is performed bilaterally. Billing 50860-50 reflects both sides. This is a temporary loop ureterostomy — the CPT code is the same as for permanent end ureterostomy. The “temporary” designation affects clinical planning (future takedown with 50830) but not CPT selection. Stage 4 CKD (N18.4) is an important CC capture here — verify the neonatologist/nephrologist has specifically staged the CKD in the documentation.

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✏️ Example 3 — Malignant Bilateral Ureteral Obstruction, Palliative Cutaneous Ureterostomy (Inpatient)

Clinical Scenario: A 65-year-old female with metastatic cervical cancer (C53.9) presents with bilateral hydronephrosis (N13.30) secondary to bilateral pelvic ureteral encasement by recurrent tumor. She has failed prior nephrostomy tube placement and is not a surgical candidate for definitive resection. Palliative bilateral cutaneous ureterostomies are performed to relieve obstruction and improve quality of life. She has an acute kidney injury (N17.9) on presentation with creatinine of 6.2, and known secondary intrapelvic lymph node metastases (C77.5).

CPT Reported:

• 50860-50 — Bilateral cutaneous ureterostomies, palliative

ICD-10-CM (Inpatient Sequencing):

1. C53.9 — Malignant neoplasm of cervix uteri (PDX — primary malignancy) — HCC 11
2. C77.5 — Secondary malignant neoplasm of intrapelvic lymph nodes — HCC 8
3. N17.9 — Acute kidney injury, unspecified (MCC) — HCC 135
4. N13.30 — Hydronephrosis, unspecified (obstructive uropathy)

ICD-10-PCS:

• 0T1B0ZA — Bypass bilateral ureters to cutaneous, open approach

MS-DRG:

• AKI (N17.9) qualifies as MCC → MS-DRG 671 (Kidney and Ureter Procedures for Neoplasm with MCC)

💡 HCC Stacking: This case captures three distinct HCC categories: HCC 11 (cervical malignancy), HCC 8 (secondary malignancy — lymph nodes), and HCC 135 (AKI). Accurate coding of all three significantly impacts risk adjustment. Note that HCC hierarchies may compress some of these — verify the specific HCC v28 hierarchy for your plan year.

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✏️ Example 4 — Post-Radiation Contracted Bladder with End-Stage Radiation Cystitis, Unilateral Right Cutaneous Ureterostomy

Clinical Scenario: A 71-year-old male with a history of prostate cancer (C61) treated with brachytherapy and external beam radiation presents with a severely contracted, fibrotic, hemorrhagic bladder secondary to radiation injury (N30.41). He has intractable gross hematuria and is not a candidate for cystectomy due to severe cardiopulmonary disease. He undergoes right-sided open end cutaneous ureterostomy as a palliative measure. He has CKD stage 3a (N18.31) and type 2 diabetes (E11.9).

CPT Reported:

• 50860-RT — Unilateral right cutaneous ureterostomy

ICD-10-CM (Inpatient Sequencing):

1. N30.41 — Irradiation cystitis with hematuria (PDX — the condition driving this admission)
2. C61 — Malignant neoplasm of prostate (active malignancy, prior treatment — report as active if currently under treatment or being managed) — HCC 12
3. N18.31 — Chronic kidney disease, stage 3a — HCC 138
4. E11.9 — Type 2 diabetes mellitus without complications

ICD-10-PCS:

• 0T160ZA — Bypass right ureter to cutaneous, open approach

MS-DRG:

• Principal diagnosis is radiation cystitis (non-neoplasm bladder category); CKD 3a = CC → MS-DRG 662 (Kidney and Ureter Procedures for Non-Neoplasm with CC)

💡 Malignancy Coding Tip: When a patient has a history of prostate cancer that has been treated, code it as active (C61) only if the documentation indicates the cancer is still present, under active treatment, or the provider is still managing it clinically as active disease. If the cancer is described as “in remission” or “resolved,” use the personal history code (Z85.46). Personal history codes carry no HCC weight — this distinction significantly impacts risk adjustment scores.

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✏️ Example 5 — Ureteral Takedown/Undiversion (Closure of Prior Cutaneous Ureterostomy)

Clinical Scenario (for contrast and completeness): A 4-year-old male previously diverted with bilateral loop cutaneous ureterostomies for prune belly syndrome (Q79.4) at 6 weeks of age now presents for planned surgical takedown and reconstruction (urinary undiversion). This is the closure procedure — NOT 50860.

CPT Reported:

• 50830 — Urinary undiversion (e.g., taking down or reversing of ureterostomy, ureterotomy)

⚠️ This example is included to illustrate that the closure of a cutaneous ureterostomy is a distinct CPT code (50830) and must NOT be reported with 50860. Always determine whether the operative note describes creation of a new diversion or closure/reversal of an existing one before code selection.

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📎 Modifier Guidance

Modifier	Use Case
-50	Bilateral cutaneous ureterostomies performed at the same session
-LT / -RT	Indicate laterality for unilateral procedure; required by many payers in addition to or instead of -50 for bilateral
-51	Multiple procedures — apply to lesser-valued procedure when 50860 is not the primary CPT at the session
-22	Increased procedural complexity — with documentation; consider for reoperative fields (prior radiation, dense adhesions, prior failed nephrostomy, obese patient with complex anatomy)
-52	Reduced services — not typically applicable to this procedure
-58	Staged procedure during global period (e.g., planned bilateral diversion staged as two separate surgical sessions)
-59	Distinct procedural service — may apply when 50860 is performed alongside a concurrent distinct procedure not normally bundled; use cautiously and document clearly
-78	Unplanned return to OR for related procedure during global period (e.g., stomal revision for acute necrosis or retraction within 90-day global)
-79	Unrelated procedure during global period
-80	Assistant surgeon
-82	Assistant surgeon when qualified resident not available

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📝 Operative Note Documentation Requirements

To support CPT 50860 specifically (and to differentiate from 50820, 50810, or 50825), the operative note must clearly document:

• Clinical indication — malignancy, obstruction, neurogenic bladder, congenital anomaly, palliation, temporary vs. permanent
• Laterality — right, left, or bilateral; if bilateral, document each side
• Approach — open vs. laparoscopic/robotic
• No bowel segment used — explicit statement that no intestinal segment was harvested or interposed (differentiates from 50820)
• Level of ureteral transection — distal, mid, or proximal ureter
• Type of ureterostomy created — end vs. loop vs. ring
• Stoma site location — right lower quadrant, left lower quadrant, midline, etc.
• Ureteral maturation technique — how the ureteral end was sutured to skin
• Stent or catheter placement — type, size, and management plan
• If bilateral, were both sides performed simultaneously? — affects modifier usage
• Temporary vs. permanent — important for clinical documentation (does not change CPT but affects future coding at takedown)
• EBL, drain placement, and wound closure details

⚠️ The single most important documentation distinction: The operative note must clearly state that urine was diverted directly from the ureter to the skin with no bowel interposition. The absence of this clarity is the primary source of coding errors between 50860 and 50820.

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🔑 Key Coding Pearls

💡 50860 vs. 50820 — The Most Critical Distinction in Urinary Diversion Coding: 50820 (ileal conduit) is far more commonly performed and far more commonly recognized by coders. Do not automatically assign 50820 for any urinary diversion. Carefully read the operative note: if a bowel segment (ileum, colon) was harvested, isolated, and used as a conduit, use 50820. If the ureter goes directly to skin with no bowel, use 50860. This is a clinically significant difference in technique with separate coding.

💡 Temporary Pediatric Loop Ureterostomy: Loop ureterostomy is a frequently performed, sometimes underappreciated procedure in pediatric urology for conditions like prune belly syndrome, posterior urethral valves, and high-grade megaureters. Even though the intent is temporary, 50860 (with -50 if bilateral) applies at the time of creation. The eventual takedown uses 50830.

💡 Bilateral Reporting: Bilateral simultaneous cutaneous ureterostomies = 50860-50, reimbursed at 150% of unilateral allowable under Medicare. Clearly document both sides in the operative note with separate descriptions if possible.

💡 Palliative Diversion Coding: When 50860 is performed for palliation of malignant obstruction, the active primary malignancy should lead as PDX if the malignancy itself drove the admission, followed by the obstructive/hydronephrosis codes and any relevant comorbidities. Never downgrade to a personal history code for an active, currently managed malignancy.

💡 HCC Maximization Opportunity: This patient population is frequently multi-morbid. Look carefully for:

• Active malignancy vs. history (HCC 8, 11, 12 vs. no HCC)
• AKI (HCC 135) precipitated by obstruction
• CKD stage (HCC 138 for stages 3-5; HCC 136 for ESRD)
• Transplant complications if applicable (HCC 136)
• Malnutrition and weight loss in oncology patients (MCC/CC opportunity) Each of these appropriately coded carries meaningful risk adjustment and DRG weight.

💡 Stoma Complications — Future Coding: Cutaneous ureterostomies are prone to stomal stenosis (the ureter is a narrow, thin-walled structure compared to ileum). Future admissions for stomal obstruction or revision should use 50727 or 50728, not 50860. A new 50860 should only be coded if a complete new ureterostomy is created, not for revision of an existing one.

💡 Documentation of Temporary Intent: Even when the intent is temporary (pediatric loop ureterostomy), code the procedure as performed. The takedown in a future encounter will have its own code (50830). Do not add a “temporary procedure” modifier — no such modifier exists for CPT purposes.

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🔗 Related Codes Quick Reference

Code	Description
50810	Ureterosigmoidostomy (ureter to sigmoid colon)
50820	Ureteroileal conduit (ileal conduit — bowel interposed)
50825	Continent diversion (Indiana pouch, Koch pouch)
50830	Urinary undiversion — takedown/closure of cutaneous ureterostomy
50770	Transureteroureterostomy (one ureter anastomosed to other)
50780	Ureteroneocystostomy, single ureter to bladder
50785	Ureteroneocystostomy with psoas hitch or Boari flap
50040	Nephrostomy with drainage
51570	Cystectomy, complete
51590	Cystectomy with continent diversion
51596	Cystectomy with continent diversion, complex
38770	Pelvic lymphadenectomy (if performed concurrently)
50727	Revision of urinary conduit/anastomosis, stomal revision
C67.4	Malignant neoplasm of posterior wall of bladder
C53.9	Malignant neoplasm of cervix uteri, unspecified
Q79.4	Prune belly syndrome
Q64.2	Congenital posterior urethral valves
N17.9	Acute kidney injury, unspecified
N18.6	End-stage renal disease
N30.41	Irradiation cystitis with hematuria
N31.2	Flaccid neuropathic bladder (spina bifida)

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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.