Summary & Overview
CPT 50920: Excision of Ureterocutaneous Fistula
CPT code 50920 denotes surgical excision of a ureterocutaneous fistula, a procedure to remove an abnormal tract between the ureter and the skin and to restore normal urinary drainage. This code is relevant for surgical urology services and for facilities reporting genitourinary operative episodes. Nationally, accurate use of this code affects procedure-level reporting, facility and physician reimbursement, and quality measurement for complex urologic wound management.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of the procedure, typical sites of service, and the clinical context in which the code is used. The publication summarizes common billing considerations, associated service lines, and typical modifiers used with operative urology codes when available. It also highlights benchmarking and policy topics relevant at a national level, including coding specificity, documentation expectations, and implications for facility versus physician reporting.
This resource is designed for coding professionals, billing managers, and clinical leaders seeking a clear, operational understanding of CPT code 50920, its clinical purpose, and the payer landscape to inform accurate claims submission and administrative workflows.
Billing Code Overview
CPT code 50920 describes the surgical removal of a ureterocutaneous fistula, an abnormal connection between the skin and the ureter. The procedure involves excision of the fistulous tract and any necessary repair of the ureter and surrounding tissues to reestablish normal urinary drainage.
Service type: Surgical procedure — genitourinary/ureteral surgery
Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–70-year-old who presents with persistent urine drainage from the flank or abdominal wall following prior ureteral surgery, urinary diversion, or traumatic injury. The patient reports continuous or intermittent clear fluid from a chronic wound or stoma site, local irritation, and occasional cellulitis. Workup includes urinalysis, urine culture, cross-sectional imaging (CT urogram or contrast fistulography) to delineate the fistulous tract between the ureter and skin, and assessment of renal function. Conservative measures (antibiotics, wound care, and diversion with ureteral stent or nephrostomy tube) may be attempted first. When the fistula persists or causes recurrent infection, fluid/electrolyte loss, or impaired quality of life, the surgical team plans operative excision of the ureterocutaneous fistula under general anesthesia. Intraoperative steps commonly include identification of the ureteral segment, excision of the fistulous tract, primary ureteral repair or reimplantation as indicated, possible ureteral stenting, hemostasis, and layered closure of the skin. Postoperative care includes wound monitoring, urinary drainage assessment, pain control, antibiotics when indicated, and imaging or cystography to confirm repair integrity prior to stent or catheter removal. Typical site of service is an inpatient or outpatient hospital operating room depending on complexity and patient comorbidities. Service type: surgical — open or limited reconstructive urologic procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normally expected performance of the service |