How To Use CPT Code 50840

CPT 50840 describes the replacement of all or part of the ureter by an intestine segment, including intestine anastomosis. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 50840?

CPT 50840 can be used to describe a surgical procedure in which a section of the intestine is used to replace all or part of the ureter. This procedure is typically performed when there are conditions such as recurring stones, ureteral cancer, or extensive ureteral injury that require the replacement of the ureter. It is important to note that for a bilateral procedure, modifier 50 should be added when reporting CPT 50840.

2. Official Description

The official description of CPT code 50840 is: ‘Replacement of all or part of ureter by intestine segment, including intestine anastomosis.’ It is worth mentioning that for a bilateral procedure, modifier 50 should be added to the code.

3. Procedure

1. The provider begins by assessing the patient’s condition and determining the need for the replacement of the ureter.
2. A nephrostomy tube may be inserted if one is not already present to drain the kidney contents into a urine collection bag.
3. A paramedian or midline incision is made, depending on whether one or both ureters are affected.
4. The provider frees the beginning of the large intestine from the surrounding tissue and divides the lateral attachments of the ascending colon.
5. The provider also frees the ascending colon, peritoneum from the bladder, and the lateral aspect of the bladder.
6. The provider then carefully determines the length of the intestine needed to replace the ureter and selects an appropriate segment of the intestine.
7. The bowel is divided close to the connective tissue, and the needed section is removed.
8. The divided intestine is then reconnected to restore continuity.
9. The excised bowel segment is flushed with saline solution until the discharge runs clear.
10. The portion of the ureter being replaced is dissected, and the intestinal segment is passed into the space.
11. The segment is rotated to place the distal end near the bladder and the proximal end close to the renal pelvis or the ureter.
12. The provider joins the proximal end of the intestinal segment to the ureter or renal pelvis and joins the distal end either to the bladder or to the top spread open end of the lower ureter, depending on whether it is a partial or complete ureteral replacement.
13. The defect in the colonic connective tissue is closed.
14. A ureter stent and a urethral catheter may be placed at the end of the procedure.

4. Qualifying circumstances

CPT 50840 is performed for patients with conditions such as recurring stones, ureteral cancer, or extensive ureteral injury that require the replacement of the ureter. The procedure is typically performed by a qualified healthcare professional who has the necessary expertise and training in urological surgeries. It is important to note that for a bilateral procedure, modifier 50 should be added when reporting CPT 50840.

5. When to use CPT code 50840

CPT code 50840 should be used when a qualified healthcare professional performs the replacement of all or part of the ureter using an intestine segment. It is important to ensure that the procedure meets the specific criteria outlined in the official description of the code. Modifier 50 should be added when reporting a bilateral procedure.

6. Documentation requirements

To support a claim for CPT 50840, the healthcare professional must document the following information:

• Patient’s diagnosis and the need for the replacement of the ureter
• Details of the procedure, including the specific segment of the intestine used
• Date of the procedure
• Any additional procedures performed, such as the insertion of a nephrostomy tube or placement of a ureter stent
• Any complications or unexpected findings during the procedure
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 50840, it is important to ensure that the procedure meets the specific criteria outlined in the official description of the code. Modifier 50 should be added when reporting a bilateral procedure. It is also important to follow any additional billing guidelines provided by the payer or relevant coding guidelines.

8. Historical information

CPT 50840 was added to the Current Procedural Terminology system on January 1, 1990. There have been historical changes to the code, including a code change on January 1, 2002, which updated the description to include the use of an intestine segment. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient with recurring stones undergoes a procedure in which a section of the intestine is used to replace the ureter.
2. A patient with ureteral cancer requires the replacement of the ureter using an intestine segment.
3. A patient with extensive ureteral injury undergoes a procedure in which a section of the intestine is used to replace the affected portion of the ureter.
4. A bilateral procedure is performed on a patient with recurring stones, using sections of the intestine to replace both ureters.