🩺 CPT 50382 — Removal (Via Snare/Capture) And Replacement Of Internally Dwelling Ureteral Stent Via Percutaneous Approach, Including Radiological Supervision And Interpretation
Quick Reference
wRVU: 5.12¹ | Global Period: 000 | Assistant Payable: No — work value falls below the threshold Medicare typically requires for separate assistant-at-surgery payment | Bilateral Indicator: 1 Rule: CPT 50382 carries a 000-day global and a PC/TC indicator of 0, meaning the radiological supervision and interpretation is bundled into the base code and cannot be separately billed with modifier -26 or -TC. Verify your specific locality’s payment file before relying on the wRVU listed above.
📋 Clinical Description
CPT 50382 describes a percutaneous exchange of an internally dwelling (double-J) ureteral stent. The physician accesses the existing nephrostomy tract, uses a snare or capture device under fluoroscopic guidance to grasp and withdraw the indwelling stent, then advances and deploys a new stent into position spanning the renal pelvis to the bladder — all in the same session. This differs from 50385, which accomplishes the identical removal-and-replacement goal via a transurethral (retrograde, non-cystoscopic) route rather than through an existing percutaneous tract, and from 50384, which removes the stent percutaneously without placing a replacement.
Because the code bundles the imaging supervision and interpretation, coders should not separately report a fluoroscopy add-on code alongside 50382 for the same encounter. The procedure is most often performed for chronic indwelling stents that require routine periodic exchange (typically every 3–6 months) to prevent encrustation, infection, or stent failure.
This procedure may be performed in the following clinical contexts:
- Routine stent maintenance — A patient with a chronic indwelling stent for malignant or benign ureteral obstruction returns for scheduled exchange before encrustation risk increases.
- Malignant ureteral obstruction — Stents placed for extrinsic compression from pelvic or retroperitoneal malignancy require periodic percutaneous exchange when retrograde access is not feasible.
- Post-lithotripsy stricture management — Patients with ureteral strictures following stone treatment may need staged percutaneous exchanges while the tract matures.
- Failed transurethral access — When cystoscopic or transurethral stent exchange is not possible (e.g., altered anatomy, urinary diversion), the percutaneous route through an existing nephrostomy tract is used instead.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Snare/capture retrieval | A wire snare or stone basket is passed through the nephrostomy tract to grasp the proximal coil of the existing stent, which is then withdrawn under fluoroscopic visualization. | Requires a mature, patent percutaneous tract; immature tracts increase risk of tract disruption during retrieval. |
| Guidewire exchange | Once the old stent is removed, a guidewire is maintained across the ureteropelvic junction to preserve access for the new stent. | Loss of wire access mid-procedure may require re-establishing the tract, which is not separately billable if completed in the same session. |
| New stent deployment | The replacement double-J stent is advanced over the wire and positioned with the proximal coil in the renal pelvis and distal coil in the bladder, confirmed fluoroscopically. | Malposition confirmed on imaging may require repositioning before the tract is closed or a nephrostomy catheter is left in place. |
Clinical Pearl
The single biggest audit risk with 50382 is confusing it with 50385 (transurethral approach) or billing a separate fluoroscopy code — both are bundling errors payers flag routinely. Confirm from the operative note whether the access was through an existing percutaneous tract (50382) or purely transurethral (50385) before assigning the code.
✅ Procedure Includes
- Fluoroscopic imaging guidance throughout stent retrieval and replacement.
- Snare or capture device passage through the existing percutaneous tract.
- Removal of the old indwelling stent.
- Guidewire maintenance across the ureteropelvic junction during exchange.
- Deployment and fluoroscopic positioning confirmation of the new stent.
- Any contrast injection performed solely to confirm stent position during the same session.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 50385 | Removal and replacement of internally dwelling ureteral stent, transurethral approach, without cystoscopy, including RS&I | Mutually exclusive with 50382 based on access route — only one should be reported per stent exchanged, chosen by the actual approach documented. |
| 50384 | Removal (via snare/capture) of internally dwelling ureteral stent, percutaneous approach, including RS&I, without replacement | Report 50384 instead of 50382 only when no new stent is placed in the same session; do not report both for a single stent exchange. |
| 74425 | Urography, retrograde, with or without KUB | Bundled when performed solely to confirm stent position as part of the 50382 session; separately reportable only if a distinct diagnostic indication and separately identifiable report exist. |
| 52332 | Cystourethroscopy with insertion of indwelling ureteral stent | Do not report together for the same ureter in the same session — 50382 explicitly excludes cystoscopic visualization; if cystoscopy was used, 52332 or a related cysto-based code applies instead. |
Bundling Alert
CPT 50382 carries a 000-day global period, meaning there is no post-procedure global package beyond the day of service, but the radiological supervision and interpretation is permanently bundled — never unbundle fluoroscopy or contrast injection codes performed solely to guide or confirm this exchange. Audit risk also rises when facilities bill both the percutaneous and transurethral stent-exchange codes for the same stent in the same encounter; only the actual access route documented in the operative note should be coded.
🌳 Code Tree — Surgery: Urinary System
CPT 50010-50593 Surgical Procedures on the Kidney
│
├── 50380-50381 Renal Autotransplantation
│
├── 50382-50389 Introduction Procedures on the Kidney (Renal Pelvis Catheter)
│ ├── 50380 Renal autotransplantation, reimplantation of kidney (Global: 090)
│ ├── ▶▶ 50382 ◀◀ Removal and replacement of internally dwelling ureteral stent, percutaneous approach, including RS&I ← YOU ARE HERE (Global: 000)
│ ├── 50384 Removal of internally dwelling ureteral stent, percutaneous approach, including RS&I (Global: 000)
│ ├── 50385 Removal and replacement of internally dwelling ureteral stent, transurethral approach without cystoscopy, including RS&I (Global: 000)
│ └── 50386 Removal of internally dwelling ureteral stent, transurethral approach without cystoscopy, including RS&I (Global: 000)
│
└── 50390-50398 Repair and Other Procedures on the Kidney
├── 50390 Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous
└── 50391 Instillation(s) of therapeutic agent into renal pelvis and/or ureter💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 5.12¹ — CMS national unadjusted, 2026 PFS file |
| Global Period | 000 — no post-procedure global package |
| Bilateral Indicator | 1 — 150% payment adjustment applies when reported bilaterally with modifier -50 or with -RT/-LT and two units |
| Assistant Surgeon | Not typically separately payable given the code’s work value; verify against your specific payer’s assistant-surgeon indicator |
| Co-Surgeon | Not typically applicable — single-surgeon percutaneous procedure |
| Team Surgery | Not applicable |
| PC/TC Split | 0 — physician service code; RS&I is bundled, modifiers -26/-TC do not apply |
| Modifier -51 Exempt | No — subject to multiple-procedure reduction when billed with other same-session surgical codes |
| Anesthesia | Typically performed under moderate sedation or local anesthesia; not usually associated with a separate anesthesia base unit code |
Bilateral Billing Rules
When stents are exchanged in both ureters during the same session, report 50382 once with modifier -50, or twice with -RT and -LT and one unit each, depending on payer preference. Confirm the payer’s specific bilateral billing convention — some MACs require -50 on a single line, others require **-RT/ -LT on two lines.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Append when the procedure is performed on the right ureter only. |
| -LT | Left Side | Append when the procedure is performed on the left ureter only. |
| -50 | Bilateral | Append when both ureters are exchanged in the same session; report per payer’s single-line vs. two-line convention. |
| -59 | Distinct Service | Use when 50382 is performed on a separate ureter or in a separate session from another same-day procedure that would otherwise be bundled. |
| -22 | Increased Procedural Services | Append with supporting documentation when the exchange requires significantly more work than typical — e.g., a severely encrusted or fractured stent requiring extended fluoroscopy time. |
| -52 | Reduced Services | Use when the procedure is started but portions are not completed as planned, without full discontinuation. |
| -53 | Discontinued | Use when the procedure is terminated after starting due to patient risk, before completion. |
| -76 | Repeat Procedure by Same Physician | Append when the same physician repeats the stent exchange later the same day. |
| -77 | Repeat Procedure by Another Physician | Append when a different physician repeats the exchange later the same day. |
| -78 | Return to OR | Use when an unplanned return to the procedure room is required for a related complication within the global period. |
| -79 | Unrelated Procedure | Use when an unrelated procedure is performed by the same physician during the (nominal) global period. |
🩺 Common ICD-10-CM Pairings
Primary Diagnosis Group
| ICD-10 | Description | HCC? | Notes |
|---|---|---|---|
| N13.30 | Unspecified hydronephrosis | ❌ No | Common primary indication when a specific cause of obstruction requiring the indwelling stent is not further specified in the documentation. |
| N20.1 | Calculus of ureter | ❌ No | Appropriate when the stent was originally placed for a ureteral stone and is now due for routine exchange. |
| N13.2 | Hydronephrosis with renal and ureteral calculous obstruction | ❌ No | Use when both hydronephrosis and the calculous obstruction are documented together as the reason for the indwelling stent. |
| N13.5 | Crossing vessel and stricture of ureter without hydronephrosis | ❌ No | Appropriate for stents placed to manage a ureteral stricture without documented hydronephrosis. |
Secondary Group
| ICD-10 | Description | HCC? | Notes |
|---|---|---|---|
| Z46.6 | Encounter for fitting and adjustment of urinary device | ❌ No | Frequently reported as the primary or first-listed diagnosis for a routine, asymptomatic stent exchange encounter. |
| N28.89 | Other specified disorders of kidney and ureter | ❌ No | Use when the underlying urinary condition necessitating the stent does not map to a more specific code. |
Etiology / Complication
| ICD-10 | Description | HCC? | Notes |
|---|---|---|---|
| T83.192A | Other mechanical complication of indwelling ureteral stent, initial encounter | ❌ No | Use when the exchange is prompted by a documented stent malfunction, migration, or encrustation rather than routine maintenance. |
| N13.6 | Pyonephrosis | ❌ No | Use when infection complicating the obstructed, stented system is documented as the reason for exchange. |
Coding Specificity Reminder
Never default to an unspecified hydronephrosis code when the operative note or history documents a specific stone, stricture, or malignant cause — payers increasingly deny percutaneous exchange claims coded only to N13.30 without a supporting etiology code on the chart.
🏥 MS-DRG Considerations
CPT 50382 maps to ICD-10-PCS codes describing removal and insertion of an intraluminal device in the ureter (see below). When captured on an inpatient claim, this pairing typically groups within MDC 11 (Diseases and Disorders of the Kidney and Urinary Tract) as a minor procedure and rarely independently drives DRG assignment to a surgical DRG unless it is the qualifying OR procedure for the stay or is accompanied by a more significant principal diagnosis such as urosepsis or acute kidney injury. There is no National Coverage Determination specific to ureteral stent exchange, and no Noridian JE/JF Local Coverage Determination was identified specifically addressing CPT 50382 as of this review — coverage is governed by standard medical-necessity documentation rather than a dedicated LCD.³
🔧 ICD-10-PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 0TP63DZ | Removal of Intraluminal Device from Right Ureter, Percutaneous Approach | Percutaneous |
| 0TP73DZ | Removal of Intraluminal Device from Left Ureter, Percutaneous Approach | Percutaneous |
| 0TH63DZ | Insertion of Intraluminal Device into Right Ureter, Percutaneous Approach | Percutaneous |
| 0TH73DZ | Insertion of Intraluminal Device into Left Ureter, Percutaneous Approach | Percutaneous |
PCS Character Analysis (using 0TH63DZ — Insertion, Right Ureter, as the reference)
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical section — the vast majority of inpatient procedural codes fall here. |
| 2 | Body System | T | Urinary System — encompasses kidney, ureter, bladder, and urethra procedures. |
| 3 | Root Operation | H | Insertion — putting in a device that monitors, assists, performs, or prevents a physiological function without physically taking the place of a body part. |
| 4 | Body Part | 6 | Ureter, Right — laterality is required; use 7 for the left ureter. |
| 5 | Approach | 3 | Percutaneous — entry through the skin via the existing nephrostomy tract, without visualization. |
| 6 | Device | D | Intraluminal Device — the classification used for internally dwelling double-J ureteral stents that do not exit the body. |
| 7 | Qualifier | Z | No Qualifier — no additional qualifier value applies to this code. |
Root Operation Comparison
- The removal component uses root operation P (Removal), while the new stent placement uses root operation H (Insertion) — the two are coded as separate PCS codes even though CPT bundles them into a single code.
- Ureteral stents are classified as device value D (Intraluminal Device) in PCS, not O (Drainage Device), because they remain entirely internal — reserve Drainage Device for externally draining catheters like nephrostomy tubes.
📝 Coding Examples
Example 1
Clinical Scenario: A patient with a chronic right ureteral stricture and an existing right nephrostomy tract presents for scheduled stent exchange. Under fluoroscopic guidance, the interventional urologist snares and removes the existing indwelling stent through the tract and deploys a new double-J stent, confirming position with contrast. No complications occur.
| Field | Code | Rationale |
|---|---|---|
| CPT | 50382--RT | Percutaneous removal and replacement of an internally dwelling stent through an existing tract, right side only. |
| PDx | Z46.6 | Encounter is for routine, scheduled device maintenance rather than an acute complication. |
Note
Example 2
Clinical Scenario: A patient with bilateral ureteral obstruction from pelvic malignancy has bilateral indwelling stents exchanged percutaneously in the same session through existing bilateral nephrostomy tracts.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 50382--50 | Bilateral percutaneous stent exchange reported per payer’s bilateral billing convention. |
| PDx | N13.2 | Documented obstruction with hydronephrosis is the underlying reason for the indwelling stents. |
Warning
Example 3
Clinical Scenario: A patient presents with fever and flank pain; imaging shows the existing indwelling stent has migrated and is causing obstruction. The stent is removed and replaced percutaneously through the existing tract in the same session that addresses the mechanical complication.
| Field | Code | Rationale |
|---|---|---|
| CPT | 50382 | Percutaneous removal and replacement of the malfunctioning stent through the existing tract. |
| PDx | T83.192A | Mechanical complication (migration) of the indwelling stent is the documented reason for the exchange, not routine maintenance. |
Global period reminder, if applicable
The 000-day global means there is no post-procedure package to protect a related E/M visit later the same week — a subsequent visit for continued symptoms is separately billable.
⚠️ Common Coding Pitfalls
- Pitfall 1: Confusing 50382 (percutaneous approach) with 50385 (transurethral approach) — the operative note must clearly document the access route used; these are not interchangeable based on outcome alone.
- Pitfall 2: Separately billing a fluoroscopy or contrast-injection code for imaging performed solely to guide or confirm the exchange — this is bundled into 50382 and unbundling is a recurring audit finding.
- Pitfall 3: Reporting 50382 when no replacement stent was actually placed — if only removal occurred, 50384 is the correct code instead.
- Pitfall 4: Defaulting to unspecified hydronephrosis (N13.30) when the chart documents a specific stone, stricture, or malignant etiology — specificity affects both accuracy and payer scrutiny.
- Pitfall 5: Inconsistent bilateral billing convention — submitting modifier -50 when the payer requires -RT/-LT on separate lines (or vice versa) frequently triggers denials or underpayment.
- Pitfall 6: Assuming the 000-day global period means no documentation is needed for a same-day E/M — a significant, separately identifiable E/M service performed the same day still requires modifier -25 and independent medical necessity.
📎 Sources
1. Find-A-Code / InnoviHealth Systems. *CPT Code 50382 — RVU Data (2026).* Sourced from CMS National Physician Fee Schedule Relative Value File. https://www.findacode.com/cpt/50382-cpt-code.html 2. American Urological Association. *2026 Medicare Physician Fee Schedule Final Rule Summary.* AUA; 2025-2026. 3. Centers for Medicare & Medicaid Services. *ICD-10-CM/PCS MS-DRG v43.1 Definitions Manual — MDC 11 Kidney and Ureter Procedures.* CMS; FY2026. https://www.cms.gov/icd10m/FY2026-fr-v43.1-fullcode-cms/fullcode_cms/Sources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.