0T184KC
Bypass Ureters, Bilateral to Ileocutaneous 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 | 8 Ureters, Bilateral |
| Approach | 4 Percutaneous Endoscopic |
| Device | K Nonautologous Tissue Substitute |
| Qualifier | C Ileocutaneous |
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: 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: Ileocutaneous
Ileocutaneous designates a bypass that connects the ileum directly to the skin surface, creating an external drainage or diversion pathway, as in an ileostomy-type procedure. It signals that intestinal content is redirected outward rather than to another internal segment of bowel. It parallels Colocutaneous but applies specifically when the ileum, not the colon, is the segment involved.
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.