0T164K7
Bypass Ureter, Right to Ureter, Left with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | T Urinary System |
| Operation | 1 Bypass |
| Body Part | 6 Ureter, Right |
| Approach | 4 Percutaneous Endoscopic |
| Device | K Nonautologous Tissue Substitute |
| Qualifier | 7 Ureter, Left |
Operation Definition
Altering the route of passage of the contents of a tubular body part
Procedure Overview
Bypass procedures in the urinary system reroute the flow of urine around a damaged, obstructed, or diseased segment so it can drain through a new path instead. Common examples include an ileal conduit or continent urinary diversion after bladder removal, a ureteroneocystostomy that reconnects a ureter to the bladder at a new site, or a yeloureteral bypass for a blocked ureteropelvic junction. These operations are performed when a tumor, stricture, chronic obstruction, or a failed bladder makes normal drainage unsafe, since backed-up urine can damage the kidneys or cause repeated infections.
Patients typically encounter these procedures alongside cancer treatment, after trauma, or when a congenital narrowing has caused progressive kidney damage. The new pathway may be temporary, to protect a healing repair, or permanent, when the original structure cannot be salvaged.
Anatomy & Axis Detail
Ureter, Right
The right ureter is the muscular tube carrying urine from the kidney pelvis to the bladder, and bypass becomes necessary when a segment is irreparably obstructed or destroyed by stricture, tumor invasion, or extensive fibrosis from prior surgery or radiation, such that the natural channel can no longer be restored by simple repair. The procedure creates an alternate route for urine, which may involve connecting healthy ureter above the defect to the bladder, bowel segment, or skin, bypassing the diseased length rather than excising it. On the right, the ureter's course near the appendix, cecum, and iliac vessels can influence which alternate pathway is feasible. Because the ureter is a tubular structure, coding depends heavily on identifying the specific conduit used to reroute flow around the obstruction.
Approach: Percutaneous Endoscopic
Percutaneous Endoscopic combines a puncture through skin or mucous membrane with insertion of an endoscope to visualize the procedure internally, as in laparoscopic cholecystectomy. It is distinguished from plain Percutaneous by the presence of scope-guided visualization, and from Via Natural or Artificial Opening Endoscopic by its route being a new puncture rather than an existing orifice or stoma.
Device: Nonautologous Tissue Substitute
Nonautologous Tissue Substitute refers to biologic material sourced from a donor or another species, such as an allograft or xenograft, used to replace a body part. It differs from Autologous Tissue Substitute by tissue origin outside the patient's own body, and from Synthetic Substitute by being biologic rather than manufactured material.
Qualifier: Ureter, Left
Ureter, Left identifies the left ureter as the secondary anatomical site in a qualifying procedure, paralleling the Ureter, Right qualifier but on the opposite side. Precise laterality here matters clinically and administratively, since unilateral left-sided involvement carries different surgical planning than right-sided or bilateral disease.
Coding & Documentation
Coders assign Bypass when documentation confirms a new route was created "from" one urinary structure "to" another (or to the skin, as in a conduit), rather than a repair of the existing channel. The operative note must name both the bypass origin and the qualifier destination, since the seventh-character qualifier changes with the target (bladder, ileum, cutaneous, etc.). A frequent error is coding Bypass when the surgeon actually performed Repair or Dilation of an existing passage rather than constructing an alternate route; another is missing the correct device value when a stent or conduit segment is left in place.