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An open ureteroneocystostomy is a surgical procedure that involves the creation of a new connection between a duplicated ureter and the bladder. This procedure is specifically indicated for patients with a duplicated collecting system, which is a congenital condition where a single kidney has two ureters. These ureters may either merge into one or drain separately into the bladder. During the procedure, the distal segment of the ureter is carefully divided at or near the ureterovesical junction (UVJ), which is the point where the ureter meets the bladder. An incision is made in the dome of the bladder wall, extending to the mucosal layer, allowing access for the surgical connection. A smaller incision is then created in the bladder mucosa to facilitate the anastomosis. The detached ureter segment is trimmed and its end is spatulated, which means it is flattened to create a larger surface area for attachment. The full thickness of the ureter is then sutured to the bladder mucosa, ensuring a secure connection. To prevent urinary reflux, the bladder wall is closed over a 2-3 cm segment of the ureter, forming a tunnel that helps maintain the integrity of the connection. The original opening at the UVJ is subsequently closed. In some cases, a temporary ureteral stent may be placed to maintain patency and support the healing process. This procedure is coded as CPT® 50782 when performed on a duplicated ureter, distinguishing it from similar procedures that may involve a single ureter or require additional surgical techniques.
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The ureteroneocystostomy procedure is indicated for patients with a duplicated ureter, which is a condition characterized by the presence of two ureters draining a single kidney. This condition may lead to complications such as urinary reflux, obstruction, or recurrent urinary tract infections. The procedure aims to create a functional connection between the duplicated ureter and the bladder, thereby addressing these potential issues and improving urinary function.
The procedure of ureteroneocystostomy involves several critical steps to ensure a successful anastomosis between the duplicated ureter and the bladder. First, the distal ureter is carefully divided at or near the ureterovesical junction (UVJ), which is the area where the ureter connects to the bladder. This division allows for the preparation of the ureter for the subsequent connection. Next, an incision is made in the dome of the bladder wall, extending down to the mucosal layer, which provides access to the interior of the bladder. Following this, a smaller incision is created in the bladder mucosa to facilitate the attachment of the ureter. The detached segment of the ureter is then trimmed to ensure it is of appropriate length and is spatulated, meaning its end is flattened to increase the surface area for the anastomosis. The full thickness of the ureter is then sutured to the bladder mucosa, creating a secure connection. To prevent urinary reflux, the bladder wall is closed over a 2-3 cm segment of the ureter, forming a tunnel that helps maintain the integrity of the connection. Finally, the original opening at the UVJ is closed to complete the procedure. In some cases, a temporary ureteral stent may be placed to ensure that the connection remains patent and to facilitate the healing process.
After the ureteroneocystostomy procedure, patients may require monitoring for any signs of complications, such as infection or urinary leakage. The placement of a temporary ureteral stent is intended to support the healing process and maintain the patency of the newly created connection between the ureter and bladder. Patients may experience some discomfort or pain at the surgical site, which can be managed with appropriate pain relief measures. Follow-up appointments are essential to assess the success of the procedure and to ensure that the urinary system is functioning properly. Additional imaging studies may be performed to evaluate the integrity of the anastomosis and to check for any potential complications. Overall, the recovery period will vary depending on the individual patient's health status and the complexity of the procedure performed.
| Short Descr | REIMPLANT URETER IN BLADDER | Medium Descr | URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR | Long Descr | Ureteroneocystostomy; anastomosis of duplicated ureter to bladder | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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). | 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.) | 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). | 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) |
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| 1993-01-01 | Added | First appearance in code book in 1993. |
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