Summary & Overview
CPT 50405: Pyeloplasty for Ureteropelvic Junction Obstruction
CPT code 50405 represents pyeloplasty, a surgical procedure to correct obstruction between the renal pelvis and ureter. Nationally, pyeloplasty is a cornerstone urologic operation for relieving ureteropelvic junction obstruction, preserving renal function, and preventing recurrent infections and pain. Accurate coding supports appropriate payment, quality tracking, and case-mix measurement for surgical services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. The discussion addresses clinical context for the procedure, typical sites of service, and common billing considerations used by these major payers.
Readers will find a concise clinical overview of the procedure, guidance on where the service is typically delivered, and what to expect in payer review and utilization contexts. The publication outlines benchmarking and policy topics relevant to pyeloplasty coding, including coding specificity, service-line classification, and factors that influence coverage and site-of-service decisions. Data not available in the input will be noted explicitly where applicable. This summary is intended for clinicians, coding professionals, and policy analysts seeking a national-level briefing on CPT code 50405 and its role in surgical urology services.
Billing Code Overview
CPT code 50405 describes pyeloplasty, a surgical reconstruction performed to correct an obstruction at the junction between the renal pelvis and the ureter. The procedure involves surgically reconstructing the area of blockage where the ureter enters the renal pelvis to restore normal urine flow and preserve renal function.
Service type: Surgical reconstructive urologic procedure
Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgical center, depending on clinical complexity and facility capabilities.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 28–45-year-old adult presenting with flank pain, recurrent urinary tract infections, and/or impaired renal function attributed to ureteropelvic junction (UPJ) obstruction. Workup includes renal ultrasound demonstrating hydronephrosis, diuretic renal scintigraphy showing diminished drainage or differential renal function, and cross-sectional imaging (CT urogram or MR urogram) to define anatomy. After conservative measures or endoscopic attempts fail or when anatomical obstruction is severe, the urologist schedules a 50405 pyeloplasty. The procedure is most often performed in an inpatient or ambulatory surgical center operating room under general anesthesia. Typical workflow: preoperative evaluation and informed consent; anesthesia induction and patient positioning; exposure of the renal pelvis and proximal ureter via an open or minimally invasive approach; excision of the obstructed segment and reconstruction of the ureteropelvic junction with or without transposition of a crossing vessel; placement of a ureteral stent as indicated; intraoperative assessment of urine drainage; postoperative monitoring in PACU with pain control, urinary stent management, and imaging follow-up (renal ultrasound or diuretic renogram) to confirm improved drainage. Common perioperative providers include urologists (pediatric or adult), anesthesiologists, surgical nurses, and radiology for pre/post imaging.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |