Summary & Overview
HCPCS C7549: Ureterostomy Tube/Stent Exchange with Stricture Dilation
HCPCS Level II code C7549 designates the change of a ureterostomy tube or externally accessible ureteral stent via an ileal conduit with concomitant ureteral stricture balloon dilation and includes imaging guidance plus radiological supervision and interpretation. This procedure code captures a combined urologic and image-guided interventional service used for managing ureteral obstruction in patients with an ileal conduit.
The analysis covers national reimbursement and coverage contexts for major payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical intent and typical settings of care, plus an overview of payer coverage patterns, common billing modifiers, and operational considerations relevant to hospital outpatient departments, ambulatory surgery centers, and interventional radiology practices.
This publication provides benchmarks and policy context to inform coding accuracy and billing workflows, highlights areas where documentation supports the composite nature of the service (tube/stent exchange plus dilation and imaging), and summarizes implications for claims adjudication and supervision/interpretation reporting. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
HCPCS Level II code C7549 describes the change of a ureterostomy tube or externally accessible ureteral stent placed via an ileal conduit, with ureteral stricture balloon dilation, and includes imaging guidance (for example, ultrasound and/or fluoroscopy) together with all associated radiological supervision and interpretation.
Service type: Procedural/interventional urologic-radiologic service involving both device exchange and endourologic dilation.
Typical site of service: Hospital outpatient department, ambulatory surgery center, or interventional radiology suite where image-guided urologic procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with a history of radical cystectomy and ileal conduit urinary diversion presents with progressive left flank pain, decreased drain output from the ileal conduit stoma, and recurrent urinary tract infections. Imaging (CT urogram and renal ultrasound) demonstrates upstream hydronephrosis and a focal narrowing at the uretero-ileal anastomosis consistent with a ureteral stricture. The interventional radiology team schedules a procedure to change the externally accessible ureterostomy tube/ureteral stent placed via the ileal conduit and perform balloon dilation of the ureteral stricture under fluoroscopic and/or ultrasound guidance.
The clinical workflow includes pre-procedure verification, review of prior imaging and labs (including coagulation status and creatinine), informed consent specific to stent exchange and dilation risks, conscious sedation or monitored anesthesia care as indicated, sterile access of the ileal conduit stomal channel, exchange of the existing stent or placement of a new ureterostomy tube, passage of a guidewire across the stricture, graded balloon dilation of the narrowed ureteral segment under fluoroscopic guidance with contrast injection to confirm patency, and post-procedure imaging to document drain position and rule out extravasation. Post-procedure monitoring includes vital signs, assessment of urine output from the conduit, and instructions for stoma care and signs of infection or obstruction.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |