How To Use CPT Code 50770

CPT 50770 refers to the surgical procedure known as transureteroureterostomy, which involves the anastomosis of one ureter to the contralateral ureter. This procedure is typically performed when a portion of the ureter has been blocked or injured, and the remaining ureter is insufficient in length to connect to the bladder. By connecting the renal end of the remaining ureter to the healthy ureter on the opposite side, the procedure aims to restore urinary flow and function.

1. What is CPT code 50770?

CPT code 50770 represents a surgical intervention known as transureteroureterostomy. This procedure is indicated when there is a significant blockage or injury to a ureter, necessitating the removal of the affected segment. The primary goal of this surgery is to create a new pathway for urine to flow from the kidney to the bladder by connecting the healthy ureter on one side of the body to the renal end of the remaining ureter on the opposite side. This technique is particularly relevant in cases where the length of the remaining ureter is inadequate for direct anastomosis to the bladder, thus requiring the use of the contralateral ureter as a conduit. The procedure is complex and requires careful dissection and suturing to ensure proper healing and function.

2. Qualifying Circumstances

This CPT code can be utilized in specific clinical situations where a ureter has been compromised due to trauma, stricture, or other pathological conditions. The use of this code is appropriate when the provider has determined that the affected ureter cannot be repaired adequately to restore normal function. It is essential that the remaining ureter is of sufficient length to allow for anastomosis to the contralateral ureter. Inappropriate use of this code would occur if the ureter could be repaired or if the procedure does not involve the anastomosis of the ureter to the contralateral side. Additionally, if the ureter is left on the same side after repair, CPT code 50700 should be used instead.

3. When To Use CPT 50770

CPT code 50770 is used when a provider performs a transureteroureterostomy following the resection of a significantly traumatized ureteral stricture. This code is specifically applicable when the surgical approach involves connecting one ureter to another across the midline of the body. It is important to note that if the procedure is laparoscopic in nature, the unlisted code for the ureter, 50949, should be used, and the billing should be benchmarked against the open procedure code 50770. Providers are advised to include a detailed operative report and a cover letter explaining the procedure in layman’s terms to facilitate proper reimbursement.

4. Official Description of CPT 50770

Official Descriptor: Transureteroureterostomy, anastomosis of ureter to contralateral ureter.

5. Clinical Application

The clinical application of CPT code 50770 is significant in the management of ureteral injuries or obstructions. This procedure is crucial for patients who have sustained damage to their ureters, as it allows for the restoration of urinary continuity and function. By rerouting urine from one kidney to the other, the procedure helps prevent complications such as hydronephrosis, infection, and loss of kidney function. The successful execution of this surgery can greatly improve a patient’s quality of life and overall health outcomes.

5.1 Provider Responsibilities

During the transureteroureterostomy procedure, the provider undertakes several critical responsibilities. Initially, the patient is prepped and anesthetized. The provider then makes a midline incision below the navel and carefully separates the rectus abdominis muscle to access the abdominal cavity. Identifying key anatomical structures, such as the large intestine and blood vessels, is essential to avoid injury during the procedure. The provider mobilizes the affected ureter, excises the blocked segment, and creates a tunnel through the sigmoid colon mesentery. The healthy ureter is then pulled across this tunnel to connect it to the remaining ureter. The provider meticulously sutures the ureters together, ensuring no tension at the anastomosis site, and places a double J stent to maintain patency. Finally, the provider closes the incision in layers after achieving hemostasis.

5.2 Unique Challenges

Transureteroureterostomy presents several unique challenges. The delicate nature of the ureter requires precision during dissection and suturing to prevent complications such as leakage or stricture at the anastomosis site. Additionally, the proximity of vital structures in the abdominal cavity necessitates careful navigation to avoid injury. The provider must also consider the potential for postoperative complications, such as infection or urinary obstruction, which can arise from the surgical site. These challenges underscore the importance of skilled surgical technique and thorough postoperative monitoring.

5.3 Pre-Procedure Preparations

Before performing a transureteroureterostomy, the provider must conduct a thorough evaluation of the patient’s medical history and imaging studies to assess the extent of the ureteral injury. Preoperative preparations may include laboratory tests to evaluate kidney function and hydration status, as well as imaging studies such as CT scans or ultrasounds to visualize the urinary tract. Ensuring the patient is adequately hydrated and has received appropriate preoperative antibiotics is also crucial to minimize the risk of infection.

5.4 Post-Procedure Considerations

After the transureteroureterostomy, the patient requires careful monitoring for any signs of complications. This includes observing for urinary leakage, infection, or obstruction. The provider may need to manage the double J stent, which typically remains in place for several weeks to support the anastomosis. Follow-up imaging may be necessary to assess the integrity of the surgical site and ensure proper urinary flow. The provider must also provide the patient with instructions regarding activity restrictions and signs of potential complications to watch for during recovery.

6. Relevant Terminology

Anastomosis: The surgical connection of two structures that were previously separated, allowing for continuity of function.

Bladder: The organ that temporarily stores urine before it is excreted from the body.

Common iliac vessel: A major blood vessel that supplies blood to the lower limbs.

Contralateral: Referring to the opposite side of the body from the area being discussed.

Double J stent: A specialized tube inserted into the ureter to keep it open and facilitate urine flow; both ends are coiled to prevent displacement.

Inferior vena cava: The large vein that carries deoxygenated blood from the lower body back to the heart.

Layers of ureter wall: The ureter consists of an outer fibrous layer, a muscular layer, and an innermost mucosal layer lining the lumen.

Lumen: The hollow space within a tubular structure, such as the ureter, through which urine flows.

Rectus abdominis: A muscle located in the front of the abdomen, important for movement and stability.

Renal end: The portion of the ureter that connects to the kidney.

Renal pelvis: The funnel-shaped structure at the upper end of the ureter that collects urine from the kidney.

Ureter: A narrow tube that carries urine from the kidney to the bladder.

Uterine artery: The blood vessel that supplies blood to the uterus in females.

7. Clinical Examples

1. A patient presents with a traumatic injury to the left ureter due to a car accident, necessitating the removal of the damaged segment and connection to the right ureter.

2. A patient diagnosed with a ureteral stricture undergoes surgery to excise the affected portion and create a new pathway for urine flow.

3. Following a failed ureteral repair, a patient requires a transureteroureterostomy to restore urinary function.

4. A patient with a congenital anomaly affecting the ureters undergoes surgery to connect the healthy ureter to the contralateral side.

5. A patient with recurrent urinary tract infections and a blocked ureter is treated with a transureteroureterostomy to alleviate the obstruction.

6. A patient with a history of cancer requiring radiation therapy develops a ureteral injury, leading to the need for surgical intervention.

7. A patient experiences a ureteral obstruction due to a kidney stone, necessitating the removal of the obstructed segment and connection to the opposite ureter.

8. A patient with a previous ureteral surgery presents with complications, requiring a transureteroureterostomy to restore normal urinary flow.

9. A patient with severe hydronephrosis due to a blocked ureter undergoes surgery to create a new urinary pathway.

10. A patient with a traumatic ureteral injury from a sports accident requires a transureteroureterostomy to prevent kidney damage.