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An ectopic ureterectomy is a surgical procedure that involves the complete removal of an ectopic ureter, which is a ureter that does not connect normally to the bladder and instead terminates in an abnormal location. This condition can occur in both males and females, with the ureter potentially ending in various structures such as the epididymis, vas deferens, ejaculatory duct, seminal vesicle, urethra, or utriculus in males, and in females, it may terminate in the Gartner's duct, upper vagina, cervix, uterus, or urethra. In rare cases, the ectopic ureter may even terminate in the rectum for both sexes. The procedure is performed using a combination of abdominal, vaginal, and/or perineal approaches to ensure complete excision of the ureter. Prior to the surgical intervention, a Foley catheter is typically placed to drain the bladder, facilitating better access to the ureter during the operation. The surgical process begins with an incision in the abdomen to expose and inspect the ureter, followed by a possible additional incision in the vagina or perineum at the site of the ureter's abnormal termination, ultimately leading to the excision of the ectopic ureter.
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The procedure of total ureterectomy for an ectopic ureter is indicated in specific clinical scenarios where the ureter is not functioning properly due to its abnormal termination. The following conditions may warrant this surgical intervention:
The procedure for total ureterectomy of an ectopic ureter involves several critical steps to ensure the successful excision of the abnormal ureter. The following procedural steps are typically followed:
After the completion of the ureterectomy, the patient will require careful monitoring and post-operative care. This may include managing pain, monitoring for signs of infection, and ensuring proper urinary function. The Foley catheter may remain in place for a period to allow for adequate bladder drainage while the surgical site heals. Follow-up appointments will be necessary to assess recovery and to ensure that there are no complications arising from the procedure. Patients may also need to be educated about potential changes in urinary function and any necessary lifestyle adjustments following the surgery.
| Short Descr | REMOVAL OF URETER | Medium Descr | URETERECTOMY TOT ECTOPIC URETER CMBN APPR | Long Descr | Ureterectomy, total, ectopic ureter, combination abdominal, vaginal and/or perineal approach | 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | 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. | 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). | 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). | 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) | 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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