Summary & Overview
CPT 50860: Ureterostomy, External Urinary Diversion
CPT code 50860 denotes creation of a ureterostomy — an external urinary diversion where the ureter is brought to the body surface to drain urine. This surgical code is used in cases where native bladder drainage is not feasible due to disease, obstruction, or prior surgery. Nationally, ureterostomy procedures are clinically important for managing complex urologic conditions and for post-operative or palliative urinary drainage.
Key payers commonly involved in coverage decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical intent of the procedure, typical sites of service, common billing modifiers associated with surgical services, and contextual guidance on how payers often categorize such surgical urinary diversion procedures. The publication also outlines benchmarks and coding relationships relevant to facility and professional claims, plus notes on documentation elements that commonly accompany this type of procedure. Data not available in the input will be identified where applicable.
Billing Code Overview
CPT code 50860 describes a surgical procedure in which the provider creates an artificial opening (stoma) and attaches the ureter to the surface of the body to allow urine drainage. This procedure establishes an external urinary diversion when normal urinary flow to the bladder is not possible or advisable.
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Service type: Surgical urinary diversion
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Typical site of service: Operating room or surgical suite in a hospital or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with obstructive uropathy, recurrent urinary tract infections, or a nonfunctioning distal urinary tract who requires urinary diversion. The patient presents to the hospital or ambulatory surgery center with flank pain, hydronephrosis on imaging, and impaired urine drainage from the kidney. After evaluation by a urologist, conservative measures and endoscopic stenting are unsuccessful or unsuitable. The provider performs an open or percutaneous ureterostomy procedure to create an external cutaneous stoma and attach the ureter to the skin to allow continuous urine drainage.
Preoperative workflow includes consent, urine culture, cross-sectional imaging (renal ultrasound or CT), coagulation assessment, and perioperative antibiotics. The patient undergoes general or regional anesthesia. The surgeon mobilizes the ureter, matures the ureteral stoma at the abdominal wall, and may place a stent or catheter for temporary drainage. Postoperative care includes stoma care education, monitoring urine output, pain control, and scheduling follow-up for stent removal or assessment for definitive reconstruction if indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician's professional services if technical component billed separately. |