Summary & Overview
CPT 50610: Open Removal of Stone from Upper Ureter
CPT code 50610 designates an open surgical incision into the upper one third of the ureter to remove a ureteral stone. This code captures a definitive, invasive intervention for proximal ureterolithiasis when endoscopic or minimally invasive approaches are unsuitable or unsuccessful. Nationally, accurate use of this code matters for clinical documentation, surgical quality measurement, and correct inpatient/outpatient reimbursement classification.
Key payers in this national overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on clinical indications and typical sites of service, plus operational considerations relevant to billing and claims processing. The publication also outlines common modifiers associated with surgical services and highlights what to expect in payer interactions and prior authorization patterns where applicable.
This analysis provides benchmarks for coding attribution, a concise summary of clinical workflow surrounding an open ureterolithotomy for the upper ureter, and a reference for coding teams verifying procedure documentation. Data not available in the input are noted where payer-specific rates, associated taxonomies, ICD-10 pairings, and related codes would normally be presented.
Billing Code Overview
CPT code 50610 describes a surgical procedure in which the provider makes an incision into the upper one third of the ureter to remove a stone from the ureter. This procedure is classified as an open ureterolithotomy focused on the proximal (upper) ureter.
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Service type: Surgical open ureteral stone removal (incision into the ureter)
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Typical site of service: Operating room or surgical suite in an inpatient or outpatient hospital setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–70 year old adult presenting with acute flank pain, gross hematuria, or recurrent ureteral colic. Imaging (non-contrast CT abdomen/pelvis or renal ultrasound) demonstrates a radiopaque calculus lodged in the proximal third of the ureter. Initial conservative management (hydration, analgesia, medical expulsive therapy) has failed or the stone is unlikely to pass because of size (>6–7 mm), persistent obstruction with hydronephrosis, infection risk, or intractable pain. The urologist schedules a surgical ureterotomy of the proximal ureter under general anesthesia.
Preoperative workflow includes history and physical, basic labs (CBC, BMP, urinalysis, urine culture), cross-sectional imaging review, consent for ureteral surgery and possible stent placement, and anesthesia evaluation. Intraoperative steps typically include cystoscopic evaluation, placement of ureteral catheter or guidewire, open or limited incision into the upper one-third of the ureter (ureterotomy) with stone extraction, inspection of the ureteral lumen, possible placement of a ureteral stent, and layered closure or omental wrap as indicated. Postoperative care includes pain control, monitoring for urinary leak or infection, stent management and a short inpatient stay or same-day discharge depending on clinical status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than usual, with documentation of additional work and rationale. |