Summary & Overview
CPT 50630: Distal Ureterotomy for Stone Extraction
CPT code 50630 represents an open surgical ureterotomy performed to remove a stone from the lower (distal) one third of the ureter. The code captures a focused surgical intervention for ureteral calculi that are not amenable to less invasive approaches. Nationally, accurate coding of this procedure affects payment, surgical quality tracking, and comparative utilization of open versus endoscopic or lithotripsy approaches.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical setting of the procedure, how this code is used in claims, and what to expect in terms of service line and site of service. Benchmarks and policy updates relevant to surgical urology billing are summarized, along with practical notes on documentation elements commonly associated with ureterotomy for stone extraction.
This summary is intended for coding professionals, revenue cycle staff, and clinical leaders who need a concise national overview of CPT code 50630, including clinical intent, typical utilization contexts, and payer coverage considerations. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
CPT code 50630 describes a surgical procedure in which the provider makes an incision into the lower one third of the ureter to remove a stone from the ureter. This is a ureterotomy for stone extraction targeting stones located in the distal ureter.
Service type: Open surgical ureterotomy for stone removal
Typical site of service: Operating room / inpatient or outpatient surgical suite, commonly performed by urology surgical teams.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting with acute flank pain, hematuria, or recurrent urinary tract infections. Imaging (non-contrast CT or ultrasound) demonstrates a radiopaque calculus lodged in the distal (lower one-third) ureter causing obstruction and pain or infection. Conservative measures (hydration, analgesia, medical expulsive therapy) are attempted when appropriate; however, for impacted stones, large stone burden, failed endoscopic retrieval, or ongoing infection/obstruction, the urologist schedules an open ureterolithotomy targeting the lower one-third of the ureter.
Preoperative workflow includes history and physical, basic labs (CBC, BMP, coagulation), urine analysis and culture, and cross-sectional imaging review. Perioperative considerations include appropriate antibiotic prophylaxis, consent for potential conversion or adjunct procedures (stent placement), and anesthesia evaluation. The operative note documents a lower ureteral incision, stone extraction, inspection of the ureter, possible ureteral stent placement, and layered closure. Postoperative care includes pain control, monitoring for urine leak or infection, stent management if placed, and follow-up imaging or cystoscopy as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure required substantially greater work than typical (e.g., extensive dissection due to adhesions). |