Summary & Overview
CPT 50840: Ureteral Replacement with Intestinal Segment
CPT code 50840 represents intestinal substitution of the ureter — a reconstructive urologic surgery that replaces all or part of the ureter with a segment of intestine. The procedure is clinically significant for treating recurrent calculi, ureteral malignancy, and severe ureteral trauma where other repairs are not feasible. Nationally, this is a specialized surgical service typically performed in hospital operating rooms and, selectively, in ambulatory surgical centers for lower-risk patients.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, common procedural considerations, and payer coverage patterns. The publication also covers billing and coding benchmarks, applicable modifier usage (listed separately), and policy updates that influence prior authorization and medical necessity review for complex reconstructive urologic procedures.
This summary equips clinicians, coding professionals, and policy analysts with a clear, national-level snapshot of CPT code 50840, its clinical indications, and the payer landscape relevant to reimbursement and utilization management. Data not available in the input is identified where applicable in detailed sections.
Billing Code Overview
CPT code 50840 describes a surgical procedure in which a segment of intestine is used to replace all or part of the ureter — the duct that carries urine from the kidney to the bladder. The operation addresses conditions such as recurrent urinary stones, ureteral cancer, and extensive ureteral injury.
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Service type: Reconstructive urologic surgery using intestinal substitution of the ureter
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Typical site of service: Inpatient surgical setting (hospital operating room) or ambulatory surgical center when clinically appropriate
Clinical & Coding Specifications
Clinical Context
A 58-year-old male with a history of recurrent ureteral calculi and progressive right ureteral stricture presents with flank pain, hydronephrosis on imaging, and declining renal function. Prior endoscopic attempts at ureteral stenting and balloon dilation failed to restore patency. Preoperative evaluation includes CT urography, renal scintigraphy to assess split renal function, basic labs, and informed consent for reconstruction. The surgical plan is an open or robotic-assisted ileal ureter substitution using a segment of the ileum to replace the diseased ureteral segment. Intraoperative steps include mobilization of the affected kidney/ureteral stump, harvest of an appropriate length of ileum with preservation of mesenteric blood supply, creation of ureteroenteric and enterovesical anastomoses, placement of internal stents or drains, and confirmation of hemostasis. Postoperative workflow includes monitoring for urine leak, bowel function, infections, electrolyte disturbances (possible hyperchloremic metabolic acidosis), and urology follow-up for stent removal and surveillance imaging. Typical sites of service are the inpatient operating room for definitive reconstruction; preoperative evaluation in outpatient urology clinic; and postoperative inpatient surgical care and possible short-stay observation for recovery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | When two surgeons work together as primary surgeons performing distinct critical portions of the ileal ureter replacement. |