Urology Coding Alert

Question:

Washington Subscriber

An ileal conduit is a 'conduit' or drainage tube that does not store urine and is made from a segment of small bowel (called the ileum). The ureters are anastomosed to the conduit and drain urine into this bowl segment. The conduit continuously drains urine into a receptacle placed on the skin. A ileal conduit is constructed to avoid using ureterocutaneous anastomoses that are prone to stricture formation and obstruction. An ileal conduit's cutaneous stoma (attachment to an opening in the skin) is less likely to contract or become obstructed.

In contrast, a neobladder is usually a storage continent device or 'bladder.' The neobladder is usually composed from both large and small bowel. As compared to an ileal conduit this stores urine as a continent substitute bladder and requires emptying periodically either by catheter drainage via a continent stoma on the skin or spontaneous voiding if constructed with connection (or anastomosis) to a retained and intact urethra.

 You are correct to use 50820 (Ureteroileal conduit [ileal bladder], including intestine anastomosis [Bricker operation]) for the construction of an ileal conduit. Remember if the urologist implants both ureters into the conduit as is usual, add modifier 50 (Bilateral procedure). However, when constructing a neobladder report CPT code 50825 (Continent diversion, including intestine anastomosis using any segment of small and/or large intestine [Kock pouch or Camey enterocystoplasty]).