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Official Description

Ureterectomy, with bladder cuff (separate procedure)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 50650 refers to a ureterectomy with bladder cuff, classified as a separate procedure. This surgical intervention involves the excision of the distal ureter, which is the portion of the ureter closest to the bladder, along with a segment of the bladder at the location of the ureteral orifice. The ureteral orifice is the opening where the ureter connects to the bladder. During the procedure, a Foley catheter is inserted to facilitate bladder drainage, ensuring that the bladder remains empty throughout the surgery. The surgical approach typically begins with an abdominal incision made over the affected ureter and bladder, allowing for direct access to these structures for inspection and evaluation. The excision process involves transecting the ureter above the area of concern, which may be an abnormality or lesion, and subsequently incising the bladder just below the ureterovesical junction (UVJ) to remove the bladder cuff. After the excision, the bladder is repaired, and a drainage tube is placed to manage any potential fluid accumulation. Finally, the incisions are closed around the drainage tube to complete the procedure. This detailed description provides a clear understanding of the surgical steps involved in a ureterectomy with bladder cuff, emphasizing the importance of careful technique and postoperative management.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure of ureterectomy with bladder cuff (CPT® Code 50650) is indicated for specific clinical scenarios where intervention is necessary. The following conditions may warrant this surgical procedure:

  • Ureteral Obstruction: This may occur due to various causes such as tumors, strictures, or stones that impede the normal flow of urine.
  • Ureteral Tumors: Malignancies or benign tumors located in the distal ureter may necessitate removal to prevent further complications.
  • Bladder Pathology: Conditions affecting the bladder, particularly at the ureteral orifice, may require excision of the bladder cuff to ensure complete removal of diseased tissue.
  • Recurrent Urinary Tract Infections: In some cases, recurrent infections linked to anatomical abnormalities may lead to the decision for surgical intervention.

2. Procedure

The ureterectomy with bladder cuff procedure involves several critical steps to ensure successful excision and repair. The following outlines the procedural steps:

  • Step 1: An abdominal incision is made over the affected ureter and bladder. This incision allows the surgeon to gain access to the internal structures for inspection and evaluation.
  • Step 2: Once the abdominal cavity is opened, the surgeon carefully exposes the distal ureter and the bladder. This step is crucial for assessing the extent of the disease and planning the excision.
  • Step 3: The distal ureter is transected above the site of the abnormality or lesion. This ensures that any potentially diseased tissue is removed along with the ureter.
  • Step 4: The bladder is then incised just below the ureterovesical junction (UVJ). This incision allows for the removal of the bladder cuff, which is the section of bladder tissue adjacent to the ureteral orifice.
  • Step 5: After the excision of both the distal ureter and the bladder cuff, the opening in the bladder is repaired. This step is essential to restore the integrity of the bladder and prevent leakage.
  • Step 6: A drainage tube is placed to facilitate the management of any fluid accumulation post-surgery. This helps in monitoring and preventing complications.
  • Step 7: Finally, the incisions are closed around the drainage tube, completing the surgical procedure.

3. Post-Procedure

After the ureterectomy with bladder cuff procedure, patients typically require careful monitoring and management. Post-operative care includes monitoring for any signs of complications such as infection or bleeding. The drainage tube placed during the surgery will need to be monitored for output and may be removed once the physician determines that it is no longer necessary. Patients may also be advised on fluid intake and urinary habits to ensure proper recovery. Follow-up appointments are essential to assess healing and to address any concerns that may arise during the recovery period. Overall, the post-procedure phase is critical for ensuring a successful outcome and minimizing the risk of complications.

Short Descr REMOVAL OF URETER
Medium Descr URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE
Long Descr Ureterectomy, with bladder cuff (separate procedure)
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P1G - Major procedure - Other
MUE 1
CCS Clinical Classification 112 - Other OR therapeutic procedures of urinary tract
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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