Summary & Overview
CPT 50972: Ureterotomy with Ureteroscopy for Ureteral Stone Removal
CPT code 50972 represents a surgical endoscopic procedure in which the ureter is incised and an endoscope is passed to inspect the ureter, renal pelvis, and kidney and to facilitate removal of ureteral stones. This procedure can include ureteral catheterization and dilation and is performed in operative settings for definitive stone management. Nationally, 50972 is clinically significant because it documents invasive ureteral access and stone extraction techniques that affect inpatient and outpatient surgical utilization, resource allocation, and payment for urologic stone care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service settings, typical payer coverage considerations, and the billing and coding essentials linked to this procedure. The publication summarizes common modifiers and discusses where this service is typically provided (hospital operating room or ambulatory surgery center). It also highlights implications for coding accuracy, claims processing, and clinical documentation to support appropriate assignment of CPT code 50972.
The report is intended for health plan analysts, revenue cycle professionals, and clinical coding staff who need a national-level briefing on the code’s clinical role, billing context, and payer relevance.
Billing Code Overview
CPT code 50972 describes an open or direct ureterotomy with ureteroscopy: the provider incises the ureter and passes an endoscope through it to examine the kidney, renal pelvis, and ureters. The procedure may include catheterization of the ureter and ureteral dilation and is performed primarily for removal of ureteral stones.
Service Type: Surgical endoscopic/urologic procedure for stone extraction and ureteral access
Typical Site of Service: Operating room or procedure suite in an acute care hospital or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 48-year-old male presents to the emergency department with acute onset right flank pain, microscopic hematuria, and nausea. Non-contrast CT scan demonstrates a 6 mm obstructing stone in the proximal right ureter with secondary hydronephrosis. The urology team evaluates the patient, reviews comorbidities and anesthesia risk, and schedules an operative ureteroscopy with possible stone extraction.
Preoperative workflow includes informed consent, pre-op labs (CBC, BMP, coagulation as indicated), and perioperative antibiotic decision-making based on urinalysis/culture results. In the operating room under general anesthesia, cystoscopy is performed to identify the ureteral orifice. A ureteral incision is not typically performed; rather, a semi-rigid or flexible ureteroscope is passed retrograde through the urethra, bladder, and ureter to visualize the stone. The procedure may include ureteral dilation, placement of a guidewire, stone fragmentation using laser lithotripsy, stone basketing or retrieval, and ureteral stent placement for drainage if indicated. Postoperative care includes analgesia, monitoring for signs of infection or ureteral injury, and discharge instructions with follow-up for stent removal if placed.
Typical site of service: Ambulatory surgery center or hospital operating room.
Service type: Diagnostic and therapeutic endoscopic ureteral procedure for stone removal (endoscopic retrograde ureteroscopy with possible dilation, fragmentation, and stent placement).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|