How To Use CPT Code 50820

CPT 50820 describes the surgical procedure known as ureteroileal conduit, which involves the creation of a passage for urine excretion following the removal of the urinary bladder. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 50820?

CPT 50820 is a code used to describe the surgical procedure called ureteroileal conduit. This procedure is performed to facilitate urine excretion after the surgical removal of the urinary bladder due to severe trauma or malignancy. It involves the creation of a passage using a portion of the intestine known as the ileum, which is connected to the ureters to divert urine into an external opening.

2. Official Description

The official description of CPT code 50820 is: ‘Ureteroileal conduit (ileal bladder), including intestine anastomosis (Bricker operation).’ This code may require the use of modifier 50 for a bilateral procedure, and if performed in combination with cystectomy, different codes should be used.

3. Procedure

1. The surgeon makes an incision below the navel in the midline and retracts the rectus abdominis muscle to gain access to the terminal ileum.
2. A portion of the ileum is isolated, leaving at least the last 25cm for salt reabsorption, and its vascularity is ensured through transillumination.
3. The surgeon sutures the cut ends of the intestine together to restore bowel continuity.
4. A window is created in the posterior layer of peritoneum to pass the distal end of the ureter through and suture it to the ileal conduit, diverting urine into it.
5. An external opening, known as a stoma, is created on the lower abdomen, and the distal end of the ileal conduit is sutured to the abdominal skin to allow urine to be collected in a stoma bag.
6. The surgeon ensures that there is no tension in the conduit and may wrap it with overlying omentum for better revascularization.
7. Drains are placed, and the wound is closed in layers.

4. Qualifying circumstances

CPT 50820 is performed on patients who have undergone surgical removal of the urinary bladder and require a new channel for urine excretion. This procedure is typically performed due to severe trauma or malignancy. It is important to note that for a bilateral procedure, modifier 50 should be appended to the code.

5. When to use CPT code 50820

CPT code 50820 should be used when the surgeon performs the ureteroileal conduit procedure, which involves the use of the ileum to create a passage for urine excretion. It is important to ensure that the procedure is performed following the surgical removal of the urinary bladder and that the appropriate documentation is provided.

6. Documentation requirements

To support a claim for CPT 50820, the surgeon must document the following information:

• Patient’s medical history and the need for the ureteroileal conduit procedure
• Details of the surgical procedure, including the use of the ileum and the anastomosis
• Date of the procedure and the duration of the surgery
• Any additional procedures performed during the same operative session
• Post-operative care instructions and any complications encountered
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT 50820, it is important to ensure that the procedure meets the necessary criteria. Modifier 50 should be appended if the procedure is performed bilaterally. Additionally, if the procedure is performed in combination with cystectomy, different codes should be used. It is important to follow payer requirements and attach the appropriate modifiers to indicate multiple procedures performed during the same operative session.

8. Historical information

CPT 50820 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2002, with the description being updated to include ‘intestine anastomosis’ instead of ‘bowel anastomosis.’ In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient undergoes surgical removal of the urinary bladder due to bladder cancer, and the surgeon performs the ureteroileal conduit procedure using the ileum to create a passage for urine excretion.
2. Following a severe trauma that resulted in the removal of the urinary bladder, a patient undergoes the ureteroileal conduit procedure with the use of the ileum to facilitate urine excretion.
3. A patient with a history of urinary bladder malignancy undergoes the ureteroileal conduit procedure to establish a new channel for urine excretion using the ileum.
4. After the surgical removal of the urinary bladder due to trauma, a patient undergoes the ureteroileal conduit procedure, which involves the creation of a passage using a portion of the intestine.
5. A patient with bladder cancer undergoes the ureteroileal conduit procedure, which involves the use of the ileum to create a passage for urine excretion following the removal of the urinary bladder.
6. Following the surgical removal of the urinary bladder due to severe trauma, a patient undergoes the ureteroileal conduit procedure using the ileum to establish a new channel for urine excretion.
7. A patient with a history of urinary bladder malignancy undergoes the ureteroileal conduit procedure, which involves the use of the ileum to create a passage for urine excretion.