🩺 CPT 50385 — Removal (Via Snare/Capture) And Replacement Of Internally Dwelling Ureteral Stent Via Transurethral Approach, Without Use Of Cystoscopy, Including Radiological Supervision And Interpretation
Quick Reference
wRVU: 4.09 | Global Period: 000 | Assistant Payable: Restricted (indicator 0 — payable only with documented medical necessity) | Bilateral Indicator: 1 Rule: CPT 50385 carries a Multiple Procedure indicator of 2 (standard multi-procedure reduction applies) and a PC/TC indicator of 0, meaning the radiological supervision and interpretation is bundled into a single physician service with no professional/technical split. Co-surgeons and team surgery are not permitted (indicator 0 for both). Documentation must explicitly confirm the absence of cystoscopy — this is the single defining audit element for this code.1,2
📋 Clinical Description
CPT 50385 describes a minimally invasive urologic exchange of an internally dwelling ureteral stent (typically a double-J/double-pigtail stent) performed entirely through the urethra without a cystoscope. The physician uses a specialized grasper, snare, or the stent’s own externalized retrieval string to withdraw the existing stent, then advances a guidewire into the ureter and places a new stent to the renal pelvis under fluoroscopic guidance, with imaging supervision and interpretation bundled into the code.1
This approach is functionally distinct from 50382 and 50384, its percutaneous-access counterparts (entry via an existing nephrostomy tract rather than the urethra), and from 52310/52332, the cystoscopic equivalents used when the stent’s distal coil cannot be captured blindly and direct endoscopic visualization is required. CPT 50385 is the “removal-and-replace” version; its companion code 50386 is used when the stent is removed without placing a new one.3
This procedure may be performed in the following clinical contexts:
- Routine planned exchange of a chronic indwelling stent for long-term obstruction (malignancy, stricture, post-surgical) when the distal coil or retrieval string is accessible at or near the meatus.
- Office-based exchange for patients who cannot tolerate repeat cystoscopy due to severe BPH, urethral stricture, or anesthesia risk.
- Bedside inpatient exchange using portable fluoroscopy when formal cystoscopy equipment/staffing is unavailable.
- Post-ureteroscopy/lithotripsy stent exchange when an externalized retrieval string was left in place at the index procedure, permitting blind transurethral capture.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Snare/Capture (No String) | A specialized grasper or snare is passed blindly through the urethra under fluoroscopic guidance to capture the distal coil of the existing stent; once withdrawn, a guidewire is threaded into the ureteral lumen and the new stent is advanced to the renal pelvis over the wire. | Requires a palpable or fluoroscopically visible stent tail within the bladder neck/urethra. If the stent has migrated fully into the bladder or ureter with no accessible tail, cystoscopy (52310/52332) is required instead — 50385 would be incorrect. |
| String-Assisted Exchange | The original stent was placed with an externalized retrieval string; gentle traction removes the stent, followed by guidewire passage and new stent placement under fluoroscopy. | The most straightforward and lowest-risk application of 50385; eliminates the need to “hunt” for the stent and reduces urothelial trauma risk. |
| Radiologic-Only Fluoroscopic Exchange | Performed with minimal direct visualization; guidewire/catheter manipulation and contrast injection confirm ureteral patency and stent position. | Documentation must explicitly state no cystoscope was used at any point; if cystoscopic visualization occurs during the same encounter, the correct code shifts to 52310 ± 52332, not 50385. |
Clinical Pearl
The single defining documentation element for 50385 is an explicit statement that no cystoscope was used. Never default to 50385 based on setting (office vs. OR) alone — if the operative note references cystoscopy, urethroscopy, or scope insertion at any point, the correct code family shifts to 52310/52332, and reporting 50385 would be an incorrect code selection at audit.
✅ Procedure Includes
- Transurethral introduction of a grasping instrument/snare to capture and withdraw the existing indwelling ureteral stent.
- Passage of a guidewire into the ureter/renal pelvis following stent removal.
- Fluoroscopic imaging supervision and interpretation to confirm guidewire and new stent positioning.
- Placement of a new indwelling ureteral stent over the guidewire.
- Confirmation of proximal (renal pelvis) and distal (bladder) coil positioning of the new stent.
- Routine immediate post-procedure monitoring for hematuria or urinary retention.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 50386 | Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without cystoscopy | Removal-only companion code; do not report with 50385 for the same stent in the same session — 50385 already includes the replacement. |
| 50382 | Removal and replacement of internally dwelling ureteral stent via percutaneous approach | Percutaneous-access counterpart; mutually exclusive approach for the same stent exchange — select based on documented access route. |
| 52310 | Cystourethroscopy with removal of foreign body/calculus/stent, simple | Cystoscopic equivalent; supersedes 50385 if a cystoscope is used at any point in the encounter. |
| 74420 | Urography, retrograde, radiological S&I | The radiological S&I in 50385 already includes this imaging; NCCI bundles 74420 into 50385 without a clinically supported modifier. |
Bundling Alert
Because the global period is 000, there is no post-operative period tied to this code itself, but NCCI edits bundle fluoroscopic guidance and retrograde pyelographic imaging into 50385 — separately billing 74420 or similar imaging codes on the same claim line is a frequent audit finding. The Multiple Procedure indicator (2) means standard reduction rules apply when 50385 is billed with other same-session endoscopic/procedural codes, and the Assistant Surgeon indicator (0) means an assistant-at-surgery modifier will deny without documented medical necessity.
🌳 Code Tree — Surgery: Urinary System, Ureter
CPT 50382-50389 Surgery: Urinary System — Ureter — Removal
│ │
│ ├── 50382 Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation (Global: 000)
│ ├── 50384 Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation (Global: 000)
│ ├── ▶▶ 50385 ◀◀ Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation ← YOU ARE HERE (Global: 000)
│ ├── 50386 Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation (Global: 000)
│ ├── 50387 Removal and replacement of externally accessible transnephric ureteral stent requiring fluoroscopic guidance, including radiological supervision and interpretation (Global: 000)
│└── 50389 Removal of nephrostomy tube, requiring fluoroscopic guidance (separate procedure) (Global: 000)💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 4.09 |
| Global Period | 000 |
| Bilateral Indicator | 1 — 150% payment adjustment for bilateral procedure applies |
| Assistant Surgeon | Restricted — indicator 0; payable only with supporting documentation establishing medical necessity |
| Co‑Surgeon | Not permitted (indicator 0) |
| Team Surgery | Not permitted (indicator 0) |
| PC/TC Split | N/A — indicator 0, physician service code, not subject to a PC/TC split |
| Modifier -51 Exempt | No — Multiple Procedure indicator is 2; standard multiple-procedure reduction rules apply |
| Anesthesia | Not bundled since the CY2017 revision removed moderate (conscious) sedation as an included component; separately reportable via 99151-99153 if furnished by the same physician, or via anesthesia CPT codes if a separate anesthesia professional is involved |
Bilateral Billing Rules
When both ureters are stented and exchanged in the same session, Medicare pays at 150% of the lesser of billed charge or fee schedule amount for the single code. Report with modifier -50 on one line, or with -RT/-LT on two lines depending on payer convention — confirm the payer’s preferred bilateral billing format before submission, as this is a frequent denial trigger for this code family.2,5
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Append when only the right ureteral stent is exchanged; CPT 50385 carries no inherent laterality, so a side modifier is required for claims specificity. |
| -LT | Left Side | Append when only the left ureteral stent is exchanged. |
| -50 | Bilateral | Append when both ureteral stents are exchanged in the same encounter; consistent with the Bilateral Indicator of 1 on the fee schedule. Confirm whether the payer prefers -50 on one line versus -RT/-LT on two lines. |
| -25 | Significant E/M | Append to a same-day E/M service only when a significant, separately identifiable evaluation beyond the routine pre-procedure assessment is documented (e.g., new symptom work-up prompting the exchange). |
| -51 | Multiple Procedures | Append when 50385 is reported with other separately payable procedures in the same session; the Multiple Procedure indicator of 2 confirms standard reduction rules apply. |
| -59 | Distinct Service | Append only when clinical documentation supports a truly separate procedural service not otherwise bundled by NCCI (e.g., a distinct, medically necessary imaging study unrelated to the stent exchange itself). |
| -52 | Reduced Services | Append if the exchange is intentionally reduced in scope (e.g., stent removed but the planned replacement is deferred due to a clinical finding), though in most such cases 50386 is the more accurate code choice. |
| -76 | Repeat Procedure, Same Physician | Append when the same physician repeats the stent exchange later in the global period or same day due to early stent failure/malposition. |
| -77 | Repeat Procedure, Different Physician | Append when a different physician repeats the exchange (e.g., on-call urologist) within the same period. |
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| N13.2 | Hydronephrosis with renal and ureteral calculous obstruction | ❌ No | Most common indication for chronic indwelling stenting and periodic exchange in stone disease. |
| N20.1 | Calculus of ureter | ❌ No | Pairs when the underlying obstructing stone remains in situ and the stent is being exchanged pending definitive stone removal. |
| N13.30 | Unspecified hydronephrosis | ❌ No | Use when hydronephrosis is documented without further etiologic or laterality specificity; specificity reminder applies. |
| C67.9 | Malignant neoplasm of bladder, unspecified | ✅ Yes (HCC 12, V28) | Pairs when extrinsic ureteral compression from bladder or pelvic malignancy is the reason for chronic stenting; verify HCC capture against current CMS-HCC V28 model files. |
| N13.6 | Pyonephrosis | ❌ No | Pairs when infected, obstructed collecting system necessitates urgent/scheduled stent exchange. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| Z96.0 | Presence of urogenital implants | ❌ No | Status code documenting the pre-existing indwelling stent being exchanged; not a substitute for the clinical indication. |
| Z46.6 | Encounter for fitting and adjustment of urinary device | ❌ No | Appropriate as a secondary code for a routine, asymptomatic scheduled exchange with no active complication. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| T83.122A | Displacement of indwelling ureteral stent, initial encounter | ❌ No | Use when the exchange is prompted by documented stent migration/malposition; the parent T83.12 category is not billable. |
| T83.192A | Other mechanical complication of indwelling ureteral stent, initial encounter | ❌ No | Use when the exchange is prompted by encrustation, obstruction, or other mechanical stent failure; the parent T83.19 category is not billable. |
Coding Specificity Reminder
Do not default to the unspecified hydronephrosis or “presence of implant” status codes when the operative note documents a specific complication (displacement, encrustation, obstruction) prompting the exchange — the T83.12x/T83.19x complication codes carry greater clinical and audit specificity and should be sequenced ahead of a status-only Z code when a true complication exists.
🏥 MS‑DRG Considerations
CPT 50385 is a minor, non-operative endoscopic-equivalent procedure (global period 000) most often performed in the office, outpatient hospital, or ASC setting; it does not appear on the CMS Inpatient-Only list. When performed during an inpatient stay, the corresponding ICD-10-PCS approach value (via natural or artificial opening, non-endoscopic) typically classifies as a non-O.R. procedure under current MS-DRG Grouper logic, meaning the exchange itself generally does not independently drive DRG assignment — the case instead groups on the principal diagnosis (e.g., hydronephrosis, ureteral calculus, or urosepsis), most often into MDC 11 medical DRGs such as 698-700 (Other Kidney and Urinary Tract Diagnoses with/without CC/MCC). Verify this against the current IPPS FY2026 Final Rule and your facility’s encoder/Grouper, since non-O.R. classification is periodically revised.6 Regarding coverage: no National Coverage Determination (NCD) specifically addresses CPT 50385; a review of the CMS Medicare Coverage Database did not identify a distinct Local Coverage Determination (LCD) or Article governing this code, so coverage is administered through general reasonable-and-necessary criteria and MAC-level claims-processing edits rather than a dedicated policy.7 Please independently confirm current LCD/Article status for your specific MAC jurisdiction, and cross-reference the CMS Physician Fee Schedule (PFS) Look-Up Tool’s displayed non-facility/facility allowed amounts against the RVU components confirmed here (Work 4.09, Non-Facility PE 25.23, Facility PE 1.08, MP RVU 0.5) — the PPRRVU file’s payment-amount columns were blank in this release, so the PFS Look-Up Tool remains the authoritative dollar-amount source.
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
0TP97DZ | Removal of intraluminal device from ureter, via natural or artificial opening | Fluoroscopic/blind transurethral |
0T766DZ | Dilation of right ureter with intraluminal device, via natural or artificial opening | Fluoroscopic/blind transurethral |
0T767DZ | Dilation of left ureter with intraluminal device, via natural or artificial opening | Fluoroscopic/blind transurethral |
0TH67DZ | Insertion of intraluminal device into right ureter, via natural or artificial opening | Alternative root operation when no dilation objective is documented |
PCS Character Analysis (illustrated on 0T766DZ)
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical section — the standard section for this class of procedure. |
| 2 | Body System | T | Urinary System — governs the ureter as the target body part. |
| 3 | Root Operation | 7 | Dilation — per AHA Coding Clinic guidance, placement of the new stent to re-establish/maintain ureteral lumen patency is coded as Dilation with device, not Insertion.4 |
| 4 | Body Part | 6 | Ureter, Right — laterality must be captured; a left- or bilateral-specific code is required if documentation indicates otherwise. |
| 5 | Approach | 7 | Via Natural or Artificial Opening — reflects the absence of cystoscopy; approach value 8 (…Endoscopic) would apply only if a scope were used. |
| 6 | Device | D | Intraluminal Device — the ureteral stent itself. |
| 7 | Qualifier | Z | No Qualifier — no additional qualifier applies to this procedure. |
Root Operation Comparison
- Per AHA Coding Clinic (2Q 2016, pp. 26-28), a ureteral stent “exchange” is coded as two separate PCS procedures — Removal of the old device, then Dilation with the new device — rather than a single Change (root operation 2) code, because the clinical objective is re-establishing ureteral patency, not simply swapping an identical device.4
- Approach value selection must mirror the CPT documentation: value 7 (non-endoscopic) for 50385/50386, versus value 8 (endoscopic) for the cystoscopic equivalents 52310/52332.
- If the operative note supports no dilation objective (e.g., a purely maintenance re-insertion), root operation Insertion (
0TH67DZ) may be more accurate than Dilation — this distinction should be confirmed with your facility’s CDI/coding leadership on a case-by-case basis.
📝 Coding Examples
Example 1
Clinical Scenario: A patient hospitalized for obstructive pyelonephritis secondary to an obstructing right ureteral calculus had a right double-J stent placed on admission. On hospital day 5, with the retrieval string intact at the meatus and persistent hydronephrosis, the urologist exchanged the stent at bedside using gentle traction under fluoroscopic guidance; a guidewire was passed and a new double-J stent placed to the right renal pelvis. No cystoscope was used.
| Field | Code | Rationale |
|---|---|---|
| CPT | 50385--RT | The string-assisted, non-cystoscopic technique matches the code descriptor exactly; -RT documents laterality since the base code carries none. |
| PDx | N13.2 | Hydronephrosis with calculous obstruction is the clinical driver for both the original stent and this exchange. |
Note
Example 2
Clinical Scenario: A patient with known pelvic malignancy causing bilateral ureteral obstruction presented to the office for scheduled bilateral stent exchange. Both stents had externalized retrieval strings. The urologist used snare/capture technique bilaterally, exchanging each stent over a guidewire under fluoroscopic guidance without cystoscopy.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 50385--50 | Bilateral indicator of 1 supports the 150% payment adjustment when reported with modifier -50 on a single line (confirm payer preference for -50 vs. -RT/-LT on two lines). |
| PDx | N13.30 | Unspecified hydronephrosis reflects bilateral involvement without further laterality/etiology detail documented. |
| Secondary | C67.9 | Malignant bladder neoplasm documented as the extrinsic cause of the bilateral obstruction requiring chronic stenting. |
Warning
Example 3
Clinical Scenario: A patient with a chronic indwelling right ureteral stent for stricture management presented for scheduled exchange. The retrieval string could not be palpated or visualized, and blind transurethral snare capture attempts failed. The urologist converted to cystoscopy to directly visualize and retrieve the stent, then placed a new stent.
| Field | Code | Rationale |
|---|---|---|
| CPT | 52310--RT and 52332--RT | Conversion to direct cystoscopic visualization means 50385 no longer applies; the encounter must be coded to the cystoscopic removal and replacement codes instead. |
| PDx | N13.30 | Underlying hydronephrosis/obstructive process necessitating the chronic stent; use a more specific stricture code (e.g., N13.5 family) if documented. |
Global period reminder, if applicable
All codes involved carry a 000 global period, so no post-operative period restrictions apply to same-day billing; the key compliance point here is code selection, not global period timing.
⚠️ Common Coding Pitfalls
- Pitfall 1: Defaulting to 50385 based on setting alone (office vs. OR). Office performance does not guarantee a non-cystoscopic technique — the operative note must explicitly confirm no cystoscope was used.
- Pitfall 2: Omitting a laterality modifier. CPT 50385 carries no inherent laterality; failing to append -RT, -LT, or -50 as appropriate creates claims ambiguity and can trigger denials.
- Pitfall 3: Separately billing bundled imaging. Fluoroscopic guidance and retrograde pyelography are included in 50385; reporting 74420 or similar codes without a clinically supported distinct-service modifier will trigger NCCI denials.
- Pitfall 4: Reporting 50385 and 50386 together for the same stent in the same session. 50386 applies only when no replacement stent is placed — reporting both is duplicative.
- Pitfall 5: Ambiguous “no cystoscopy” documentation. Audit-defensible claims require explicit operative-note language; vague documentation invites downcoding or code-family disputes during payer review.
- Pitfall 6: Billing an assistant surgeon without supporting documentation. The Assistant Surgeon indicator of 0 restricts payment unless medical necessity is separately documented and submitted; routine use of -80/-82/-AS without this support will deny.
📎 Sources
1 American Medical Association, CPT® 2026 Professional Edition, Surgery: Urinary System, Ureter — Removal (50382-50389).2 Centers for Medicare & Medicaid Services, National Physician Fee Schedule Relative Value File (PPRRVU2026 January Release, QPP), effective January 2026.
3 AAPC Urology Coding Alert, "Know What Differentiates Renal Pelvis Catheter Procedures," Procedure Focus, 2017 (code descriptors current through CY2026 review).
4 AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, 2nd Quarter 2016, pp. 26-28, "Exchange of Ureteral Stent."
5 CMS Medicare Physician Fee Schedule (PFS) Look-Up Tool, accessed for CY2026 bilateral/RVU cross-verification.
6 CMS IPPS FY2026 Final Rule and MS-DRG Grouper documentation, MDC 11, DRGs 698-700.
7 CMS Medicare Coverage Database (MCD), NCD/LCD search for CPT 50385, reviewed August 2026.
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.