CPT® Code 50386

Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation

The procedure described by CPT® Code 50386 involves the removal of an internally dwelling ureteral stent using a transurethral approach, specifically employing a snare or capture device. This method is performed without the aid of cystoscopy, which is a procedure that typically allows for direct visualization of the bladder and urethra. Instead, fluoroscopic guidance is utilized to ensure accurate placement and removal of the stent. A ureteral stent is a flexible tube, comparable in size to a strand of spaghetti, designed to maintain the patency of the ureter, facilitating the drainage of urine from the kidney to the bladder, particularly in instances of obstruction or blockage. The stent is generally intended for temporary use, remaining in place until the underlying obstruction is resolved, which may take several weeks to months. During the procedure, a catheter is inserted into the bladder, and contrast material is injected to enhance visualization of the urinary tract. A guidewire is then maneuvered into the bladder, allowing for the replacement of the initial catheter with a larger one. The snare or capture device is advanced to grasp the distal pigtail of the ureteral stent, enabling its removal into the bladder and urethra. Following this, a guidewire is introduced through the stent and advanced into the renal pelvis under fluoroscopic guidance. The stent is subsequently extracted, and a catheter is placed over the guidewire. Additional contrast is injected, the catheter is removed, and a new stent is positioned appropriately within the urinary tract. The correct placement of the stent is confirmed through fluoroscopy, and X-ray images are obtained to document its accurate positioning. It is important to note that if the ureteral stent is removed without being replaced, the specific code to use is 50386.