0T184J9
Bypass Ureters, Bilateral to Colocutaneous with Synthetic 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 | 8 Ureters, Bilateral |
| Approach | 4 Percutaneous Endoscopic |
| Device | J Synthetic Substitute |
| Qualifier | 9 Colocutaneous |
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
Ureters, Bilateral
Bilateral ureteral bypass addresses obstruction or destruction affecting both ureters simultaneously, a situation more often caused by diffuse retroperitoneal fibrosis, extensive pelvic malignancy, or bilateral radiation injury than by isolated stone disease. Because both drainage pathways are compromised, the procedure typically reroutes urine from each ureter independently to a common or separate diversion, frequently using a segment of bowel, since simple two-sided repair is not an option when the underlying disease process affects both sides equally. The bilateral nature raises the stakes considerably, as failure of the bypass threatens the entire renal reserve rather than one kidney. Documentation should reflect that both ureters were addressed in the same operative episode and specify the conduit each was routed through, even if the anatomic solution differs from one side to the other.
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: Synthetic Substitute
Synthetic Substitute designates a device made from manufactured, non-biologic material, such as mesh or prosthetic components, used to replace or augment a body part. It is distinguished from the two tissue substitute categories by its artificial composition, which carries different considerations for integration and long-term durability than biologic grafts.
Qualifier: Colocutaneous
Colocutaneous describes a bypass that creates a connection between the colon and the skin surface, effectively establishing an external opening such as a colostomy-type diversion. It is chosen when intestinal contents are rerouted to exit the body externally rather than into another internal structure. This contrasts with the plain Colon qualifier, which denotes an internal colon-to-colon or colon-to-organ route.
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.