Summary & Overview
CPT 50620: Open Ureterotomy for Mid‑Ureter Stone Removal
CPT code 50620 represents an open surgical ureterotomy targeting the middle third of the ureter to remove an obstructing stone. The procedure is clinically significant because retained ureteral stones can cause acute pain, infection, obstruction, and potential loss of renal function; open ureterotomy remains a necessary option when less invasive approaches are contraindicated or unsuccessful. Nationally, proper coding and documentation of CPT code 50620 affect surgical case classification, resource utilization, and claims processing for inpatient and outpatient surgical settings.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context for mid-ureteral stone removal, common billing modifiers used with surgical procedures, and the typical sites of service where the procedure is performed. The report summarizes benchmark considerations for reimbursement and claims submission practices, highlights documentation elements that support medical necessity for open ureterotomy, and outlines areas where policy updates or payer-specific rules commonly influence adjudication. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 50620 describes a surgical procedure in which the provider makes an incision into the middle one third of the ureter to remove a stone from the ureter. This is a direct open ureterotomy focused on extraction of a ureteral calculus located in the mid-ureter.
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Service type: Open surgical ureterotomy for stone extraction
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Typical site of service: Operating room or surgical suite in an acute care hospital or ambulatory surgical center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 48-year-old male presents to the emergency department with acute, severe left flank pain, nausea, and hematuria. Imaging with non-contrast CT confirms a 6 mm obstructing calculus lodged in the mid-ureter with proximal hydroureter and pyelocaliectasis. Conservative measures including hydration and analgesia fail to relieve obstruction and the patient develops worsening renal colic and rising serum creatinine. The urology team schedules an open or minimally invasive ureterotomy to directly remove the impacted stone from the middle third of the ureter.
The clinical workflow includes: preoperative assessment and informed consent, anesthesia evaluation (usually general), intraoperative cystoscopy and ureteral catheterization as needed, a limited incision into the mid-ureter (ureterotomy) to extract the stone, inspection and repair of the ureter with possible stent placement (double-J stent) for drainage, and postoperative monitoring for urine leak, infection, and renal function. Typical inpatient stay ranges from same day to 1–3 days depending on comorbidities and intraoperative findings. Applicable payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Provider performed the service | Use when the surgeon performs the primary procedure without complications or unusual services beyond the typical. |