🩺 CPT 50386 — Removal (Via Snare/Capture) of Internally Dwelling Ureteral Stent Via Transurethral Approach, Without Use of Cystoscopy, Including Radiological Supervision and Interpretation
Quick Reference
wRVU: 2.97¹ | Global Period: 000 | Assistant Payable: No (typical for this procedure family) | Bilateral Indicator: 1 Rule: CPT 50386 is defined by its lack of an endoscope — the moment a cystoscope is introduced to visualize and grasp the stent, the encounter reclassifies to CPT 52310 and 50386 no longer applies.³
📋 Clinical Description
CPT 50386 describes a “blind,” non-visualized removal of an internally dwelling ureteral stent (commonly a double-J or Gibbons-type stent) via a transurethral approach, using a snare or grasping instrument to capture an externalized stent “dangle” or tail without cystoscopic visualization, and relying on fluoroscopic radiological supervision and interpretation (S&I) instead of direct endoscopic guidance.³ The code sits in the ureter/kidney introduction-procedure family (50382–50389), which is organized around two variables: approach (percutaneous versus transurethral) and whether the stent is removed alone or removed-and-replaced in the same session.
Two sibling codes define the boundaries of 50386 most clearly. CPT 50385 describes the identical transurethral, non-cystoscopic approach but adds replacement of a new stent in the same session, making 50385 the “removal-and-replace” counterpart to 50386’s “removal-only” scope. CPT 52310, by contrast, requires cystoscopic visualization to grasp the stent or foreign body from the urethra or bladder — per published coding guidance, if a cystoscope is used at any point to see and grasp the dangle, 52310 replaces 50386 regardless of how the description is documented.³
This procedure may be performed in the following clinical contexts:
- Routine, scheduled removal of a temporary post-operative ureteral stent whose dangle remains accessible at the urethral meatus, performed without cystoscopy in the office or outpatient setting.
- Removal of a malfunctioning, encrusted, or migrated stent identified on imaging, where the provider elects a blind snare technique rather than a full cystoscopic procedure.
- Removal of a stent placed after ureteroscopy, lithotripsy, or ureteral reimplantation once the post-operative healing interval has passed and imaging confirms adequate ureteral patency.
- Removal performed under fluoroscopic guidance alone in patients for whom cystoscopy is contraindicated, not tolerated, or unnecessary given a visible/palpable dangle.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Transurethral snare/capture (50386) | A snare or grasping instrument is passed transurethrally to capture the stent’s distal dangle without cystoscopic visualization; fluoroscopy provides S&I to confirm stent position and successful extraction. | Code selection depends on the dangle being directly graspable without needing to see it endoscopically; documentation should explicitly state cystoscopy was not used. |
| Percutaneous snare/capture (50384/50382) | The stent is accessed and captured through an existing nephrostomy tract or percutaneous access rather than transurethrally. | Used when the proximal (renal) end of the stent, not the distal dangle, is the accessible point of capture — typically in patients with an existing nephrostomy. |
| Cystoscopic removal (52310/52315) | A cystoscope is introduced into the bladder to directly visualize the stent before a grasper removes it. | Required whenever the dangle is not palpable/visible at the meatus or has migrated into the bladder; converts the encounter away from the 50382–50389 family entirely. |
Clinical Pearl
The defining audit risk with 50386 is documentation that implies cystoscopy occurred (e.g., “cystoscope advanced,” “bladder visualized”) while the CPT selected is 50386 — since 50386 explicitly excludes endoscopic visualization, any mention of a scope should trigger a code review toward 52310 instead.³ Because 50386’s RVU basis assumed anesthesia and imaging with a rigid instrument, some payers scrutinize claims where neither anesthesia nor imaging documentation is present.³
✅ Procedure Includes
- Transurethral passage of a snare or grasping instrument to the level of the stent dangle.
- Capture and extraction of the internally dwelling ureteral stent without endoscopic (cystoscopic) visualization.
- Fluoroscopic imaging guidance used to confirm instrument position and successful stent retrieval.
- Radiological supervision and interpretation (S&I) of the fluoroscopic images obtained during the procedure.
- Local or topical anesthesia administered as part of the minor procedure, when used.
- Post-removal confirmation that the stent has been fully extracted, without a retained fragment.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 52310 | Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple | Mutually exclusive by definition — if a cystoscope is used to visualize and grasp the stent, 52310 (or 52315 for complicated removal) applies instead of 50386, even if the operative note also mentions a snare.³ |
| 50385 | Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation | Represents the “removal-and-replace” version of the identical technique; only one of 50385/50386 is reported per stent per session, chosen by whether a new stent is placed. |
| 50384 | Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation | Distinguished by access route (percutaneous nephrostomy tract) rather than transurethral; not reported together for the same stent. |
| 52332 | Cystourethroscopy, with insertion of indwelling ureteral stent | Represents stent placement, not removal; commonly follows 50386 in a separate encounter but is not billed with it on the same claim line for the same stent event. |
Bundling Alert
CPT 50386 carries a global period that has historically been treated as 000 days, meaning any medically necessary E/M service performed on the same date for a separate problem may require modifier -25 on the E/M code — but confirm the current global indicator directly in the CMS PFS Lookup Tool before relying on this.¹ NCCI Urinary System edits also bundle several stent-manipulation codes together with a modifier indicator of 1, meaning a clinically supported, medically necessary override (typically -59 or an X-modifier) is required to unbundle them rather than an automatic allowance.²
🌳 Code Tree — Surgery: Urinary System (Kidney)
CPT 50010-50593 Surgery: Urinary System — Kidney
│
├── 50382-50389 Renal Pelvis Catheter Introduction Procedures
│ ├── 50382 Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation
│ ├── 50384 Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation
│ ├── 50385 Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation
│ ├── ▶▶ 50386 ◀◀ Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation ← YOU ARE HERE (Global: 000, verify)
│ ├── 50387 Removal and replacement of externally accessible nephroureteral catheter requiring fluoroscopic guidance, including radiological supervision and interpretation
│ └── 50389 Removal of nephrostomy catheter requiring fluoroscopic guidance, including radiological supervision and interpretation
│
└── 52310-52315 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder
├── 52310 Simple
└── 52315 Complicated💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 2.97¹ |
| Global Period | 000 (typical for this code family) |
| Bilateral Indicator | 1 - Confirm in CMS PFS Lookup Tool¹ |
| Assistant Surgeon | Typically not separately payable for this minor procedure — confirm in CMS PFS Lookup Tool¹ |
| Co‑Surgeon | Not typically applicable — single-provider minor procedure |
| Team Surgery | Not applicable |
| PC/TC Split | S&I component may carry a technical/professional split when billed by separate providers |
| Modifier -51 Exempt | Not exempt — subject to multiple-procedure reduction when billed with other same-session procedures |
| Anesthesia | Typically local/topical only; general anesthesia not inherent to the code description |
Bilateral Billing Rules
Ureteral stents are unilateral devices, so bilateral reporting only applies when stents are removed from both ureters in the same session — in that case, append modifier -50 or report with -RT/-LT per your MAC’s preferred convention, and confirm the payment adjustment percentage against the bilateral indicator in the CMS PFS Lookup Tool.¹
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Append when the stent removed is from the right ureter, per your MAC’s laterality-reporting convention. |
| -LT | Left Side | Append when the stent removed is from the left ureter. |
| -50 | Bilateral | Append when stents are removed from both ureters in the same session; confirm payer preference for -50 versus separate -RT/-LT lines. |
| -51 | Multiple Procedures | Append when 50386 is reported with other significant, separately payable procedures performed in the same session. |
| -59 | Distinct Service | Append to override an NCCI edit when 50386 represents a separate, medically necessary service distinct from a bundled column-1 code, with clinical documentation supporting the distinction.² |
| -52 | Reduced Services | Append when the removal is electively reduced in scope (e.g., partial removal with a planned staged completion). |
| -53 | Discontinued | Append when the procedure is started but terminated before completion due to extenuating circumstances. |
| -76 | Repeat Procedure | Append when the same provider repeats stent removal on the same day, such as after a failed initial attempt. |
| -78 | Return to OR | Append when a related procedure requires an unplanned return to the operating room during the global period of a prior related surgery. |
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| Z46.6 | Encounter for fitting and adjustment of urinary device | ❌ No | Reported for routine, scheduled stent removal with no underlying malfunction — the most common primary diagnosis for a straightforward 50386 encounter. |
| N20.1 | Calculus of ureter | ❌ No | Supports removal when the stent was encrusted with, or placed for, ureteral calculi requiring extraction. |
| N13.30 | Unspecified hydronephrosis | ❌ No | Appropriate when the stent was placed and is now being removed for hydronephrosis without a more specific etiology documented. |
| N13.5 | Crossing vessel and stricture of ureter without hydronephrosis | ❌ No | Supports cases where the stent was placed for a ureteral stricture rather than a stone or malignant obstruction. |
| Z48.816 | Encounter for surgical aftercare following surgery on the genitourinary system | ❌ No | Appropriate when removal occurs as planned aftercare following a recent ureteroscopy, lithotripsy, or reconstructive procedure. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| N28.89 | Other specified disorders of kidney and ureter | ❌ No | Reported as a secondary code when a non-specific renal/ureteral finding accompanies the primary indication for removal. |
| N39.0 | Urinary tract infection, site not specified | ❌ No | Supports cases where the stent is removed earlier than planned due to a concurrent, documented UTI. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| T83.098A | Other mechanical complication of other urinary devices and implants, initial encounter | ❌ No | Use when the stent is being removed specifically because of a documented mechanical malfunction (migration, fracture, encrustation) rather than routine completion of therapy. |
| N99.89 | Other postprocedural complications and disorders of genitourinary system | ❌ No | Supports removal driven by a postprocedural genitourinary complication distinct from a device-mechanical issue. |
Coding Specificity Reminder
Do not default to Z46.6 when the documentation supports a more specific reason for removal — a malfunctioning, encrusted, or infected stent should be coded to the mechanical complication or infection code instead, since payer medical-necessity edits increasingly distinguish “routine” from “complicated” stent removal. Always confirm laterality and etiology are documented before finalizing the diagnosis pairing.
🏥 MS‑DRG Considerations
CPT 50386 itself does not drive MS-DRG assignment in the inpatient setting because MS-DRGs are grouped from ICD-10-PCS codes, not CPT codes — the PCS equivalents below (Removal of Intraluminal Device from Ureter) are what an inpatient abstractor should assign for grouping purposes. When performed as a stand-alone minor bedside or interventional-radiology procedure during an otherwise medical admission, this removal is unlikely to independently trigger a surgical MS-DRG and more often functions as a non-OR procedure that does not affect DRG assignment. No National Coverage Determination (NCD) specifically addresses ureteral stent removal, and a dedicated Noridian (JE/JF) Local Coverage Determination (LCD) naming CPT 50386 was not identified in this review — coverage is instead governed by general medical-necessity documentation standards and the urology-specific NCCI PTP edits, so confirm against any active Noridian article or LCD at the time of billing.²
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 0TP57DZ | Removal of Intraluminal Device from Right Ureter, Via Natural or Artificial Opening | Endoscopic/transurethral, non-visualized |
| 0TP67DZ | Removal of Intraluminal Device from Left Ureter, Via Natural or Artificial Opening | Endoscopic/transurethral, non-visualized |
| 0TP77DZ | Removal of Intraluminal Device from Ureters, Bilateral, Via Natural or Artificial Opening | Endoscopic/transurethral, non-visualized |
| 0TP87DZ | Removal of Intraluminal Device from Ureter, Via Natural or Artificial Opening | Endoscopic/transurethral, non-visualized (laterality not specified) |
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical section — covers the vast majority of inpatient procedures including device removal. |
| 2 | Body System | T | Urinary System — encompasses kidney, ureter, bladder, and urethra structures. |
| 3 | Root Operation | P | Removal — taking out a device from a body part; distinct from Extraction (pulling out solid matter) or Extirpation (removing solid matter such as a stone). |
| 4 | Body Part | 5/6/7/8 | Specifies laterality — Right Ureter, Left Ureter, Ureters Bilateral, or unspecified Ureter, depending on documentation. |
| 5 | Approach | 7 | Via Natural or Artificial Opening — reflects the transurethral route without an endoscope, distinguishing it from the endoscopic value (8) used for cystoscopic removals. |
| 6 | Device | D | Intraluminal Device — the general PCS device category for a ureteral stent. |
| 7 | Qualifier | Z | No Qualifier — no additional qualifying detail applies to this removal. |
Root Operation Comparison
- Removal (P) applies here because the stent is a previously placed device being taken out entirely, with no tissue being cut, dilated, or destroyed in the process.
- Extraction (D) would apply instead if the procedure involved pulling out solid matter such as an impacted stone, not a placed device.
- Extirpation (C) would apply if solid matter (e.g., encrusted calcified debris) had to be physically taken out from within the ureter apart from the stent itself.
📝 Coding Examples
Example 1
Clinical Scenario: A patient returns three weeks after ureteroscopy with lithotripsy for a scheduled removal of a temporary double-J stent. The stent’s dangle is visible at the urethral meatus. Using a small grasping forceps and fluoroscopic guidance, the provider captures and withdraws the stent transurethrally without introducing a cystoscope. The patient tolerates the procedure well with no complications.
| Field | Code | Rationale |
|---|---|---|
| CPT | 50386-RT | Non-cystoscopic, transurethral snare removal with fluoroscopic S&I matches the code descriptor exactly; laterality modifier applied per documentation. |
| PDx | Z48.816 | Removal is planned surgical aftercare following the recent ureteroscopy/lithotripsy procedure, not a routine device-only encounter. |
Note
Example 2
Clinical Scenario: An inpatient develops fever and flank pain three months after stent placement; imaging shows the stent has migrated distally with visible encrustation. Interventional radiology performs transurethral snare removal under fluoroscopy without cystoscopy, and the patient is started on antibiotics for a concurrent urinary tract infection.
| Field | Code 1 | Code 2 | Rationale |
|---|---|---|---|
| CPT | 50386 | — | Removal-only technique matches; no replacement stent placed in this encounter. |
| PDx | T83.098A | N39.0 | Mechanical complication (migration/encrustation) is the primary driver of removal, with the concurrent UTI coded as an additional diagnosis supporting inpatient severity. |
Warning
Example 3
Clinical Scenario: A urologist attempts transurethral snare removal of a ureteral stent in the office, but the dangle cannot be grasped blindly; the provider converts to a cystoscope to directly visualize and remove the stent in the same encounter.
| Field | Code | Rationale |
|---|---|---|
| CPT | 52310 | Once a cystoscope is introduced to visualize the stent, the encounter no longer meets the 50386 descriptor and must be reported as a cystourethroscopic removal instead.³ |
| PDx | Z46.6 | Routine device removal/adjustment remains the appropriate primary diagnosis, since no malfunction was documented before the approach changed. |
Global period reminder, if applicable
⚠️ Common Coding Pitfalls
- Pitfall 1: Billing 50386 when the operative note documents cystoscopic visualization of the stent — any mention of a scope reclassifies the service to 52310 or 52315.³
- Pitfall 2: Defaulting to Z46.6 for every stent removal without checking whether a mechanical complication or infection code is better supported by the documentation.
- Pitfall 3: Confusing 50386 (removal only) with 50385 (removal and replacement) when a new stent was actually placed in the same session — this affects both reimbursement and the accuracy of the procedure history.
- Pitfall 4: Assuming percutaneous-approach codes (50382/[50384]) are interchangeable with 50386/50385 — approach route is a defining, non-negotiable element of code selection in this family.
- Pitfall 5: Failing to append modifier -25 to a same-day, separately identifiable E/M service without first confirming the current global period in the CMS PFS Lookup Tool.
- Pitfall 6: Reporting bilateral stent removal as two separate line items without checking payer preference for modifier -50 versus -RT/-LT convention, risking a denial or underpayment.
📎 Sources
1. Centers for Medicare & Medicaid Services. *Medicare Physician Fee Schedule Look-Up Tool.* CMS.gov; accessed 2026. 2. Centers for Medicare & Medicaid Services. *National Correct Coding Initiative Policy Manual, Chapter VII — Urinary System.* CMS; 2026. 3. Urology Times. *What are your options for billing for ureteral stent removal?* Urology Times; 2026. https://www.urologytimes.com/view/what-are-your-options-for-billing-for-ureteral-stent-removalSources 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.