0T18477
Bypass Ureters, Bilateral to Ureter, Left with Autologous 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 | 7 Autologous 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
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: Autologous Tissue Substitute
Autologous Tissue Substitute identifies a device value where material harvested from the patient's own body, such as an autograft, is used to replace or reconstruct a body part. Its defining feature is tissue origin from the patient, setting it apart from Nonautologous Tissue Substitute, sourced from a donor or animal, and Synthetic Substitute, made of 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.