How To Use CPT Code 50650

CPT 50650 describes the surgical procedure known as ureterectomy with bladder cuff excision. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 50650?

CPT 50650 is a code used to describe the surgical removal of all or part of a ureter along with a section of the bladder cuff. This procedure is commonly performed to treat ureteral cancer. It involves the excision of the affected area and the subsequent closure of the bladder opening. The provider may also place a catheter and drainage tube to aid in the healing process.

2. Official Description

The official description of CPT code 50650 is: ‘Ureterectomy, with bladder cuff (separate procedure).’ This code represents the surgical removal of a segment or the entire ureter, along with the excision of the bladder cuff.

3. Procedure

1. The provider makes an incision in the abdominal skin overlying the urinary bladder.
2. He then dissects through the subcutaneous tissue to expose the bladder and the lower portion of the ureter.
3. The bladder is mobilized, and the provider excises the necessary portion of the bladder cuff, including the ureteral opening.
4. He also dissects above the affected area to ensure complete removal of the diseased portion of the ureter and bladder cuff.
5. After completing the ureterectomy and bladder cuff excision, the provider places a catheter, closes the bladder opening, and inserts a drainage tube.
6. The abdominal wound is closed by suturing the layers of tissue together.
7. The drainage tube and catheter are typically removed after five days.

4. Qualifying circumstances

CPT 50650 is performed when a patient has ureteral cancer or another condition that necessitates the removal of all or part of the ureter and the bladder cuff. The procedure is typically carried out by a qualified healthcare professional who has the necessary expertise in urological surgery. It is important to note that CPT 50650 should not be reported if it is performed in conjunction with a related procedure in the same anatomic area or through the same incision, orifice, or surgical approach.

5. When to use CPT code 50650

CPT code 50650 should be used when a provider performs a ureterectomy with bladder cuff excision as a separate procedure. It should not be reported when performed along with a related procedure in the same anatomic area or through the same incision, orifice, or surgical approach.

6. Documentation requirements

To support a claim for CPT 50650, the provider must document the following information:

• Patient’s diagnosis necessitating the ureterectomy with bladder cuff excision
• Details of the procedure, including the specific areas excised and any additional steps taken
• Date of the procedure
• Start and end times of the procedure
• Any complications or unexpected findings during the procedure
• Post-operative care instructions
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 50650, ensure that the procedure is performed as a separate procedure and not in conjunction with a related procedure in the same anatomic area or through the same incision, orifice, or surgical approach. It is important to follow the specific guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT 50650 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. However, it is worth noting that Medicare added CPT 50650 to the Inpatient Only (IPO) list in 2017, indicating that it is typically performed in an inpatient setting.

9. Examples

1. A urologist performs a ureterectomy with bladder cuff excision to treat a patient with ureteral cancer.
2. A patient presents with a recurrent urinary tract infection, and the provider determines that a ureterectomy with bladder cuff excision is necessary to address an underlying abnormality.
3. A urological surgeon performs a ureterectomy with bladder cuff excision as part of a comprehensive treatment plan for a patient with a complex urological condition.
4. A patient with a history of bladder cancer undergoes a ureterectomy with bladder cuff excision to remove a diseased portion of the ureter and bladder cuff.
5. A provider performs a ureterectomy with bladder cuff excision to address a congenital abnormality in a patient’s urinary tract.
6. A urologist performs a ureterectomy with bladder cuff excision to treat a patient with a recurrent ureteral stricture.
7. A patient with a history of kidney stones undergoes a ureterectomy with bladder cuff excision to remove a portion of the ureter affected by chronic stone formation.
8. A provider performs a ureterectomy with bladder cuff excision to address a ureteral injury sustained during a previous surgical procedure.
9. A patient with a history of radiation therapy for pelvic cancer undergoes a ureterectomy with bladder cuff excision to address radiation-induced damage to the ureter and bladder cuff.
10. A urological surgeon performs a ureterectomy with bladder cuff excision to remove a segment of the ureter affected by a rare urological condition.