This edition of In the kNOW will be presenting information on a procedure highlighted in the April 2026 ICD-10-PCS updates—the Boari bladder flap. This surgical technique is used in the reconstruction of the ureter when a segment of the ureter has been damaged, removed, or is otherwise unable to function properly. Ureteral injuries may occur due to trauma, disease, or complications from prior surgical procedures. The Boari bladder flap is generally used when the ureteral segment requiring reconstruction is long or there is not enough mobility of the ureteral segment to perform a primary repair.
During a Boari bladder flap procedure, a portion of the bladder wall is surgically mobilized and shaped into a flap that can be extended upward to bridge the gap between the bladder and the remaining healthy portion of the ureter. This technique allows the surgeon to restore urinary flow from the kidney to the bladder without the need for more complex grafting procedures.
During a Boari bladder flap procedure, a portion of the bladder wall is surgically mobilized and shaped into a flap that can be extended upward to bridge the gap between the bladder and the remaining healthy portion of the ureter. This technique allows the surgeon to restore urinary flow from the kidney to the bladder without the need for more complex grafting procedures.
Source: https://operativereview.com/ureter-injury/
From a coding perspective, the April 2026 ICD-10-PCS update introduced a new table specifically designed to capture reconstruction of the ureter, which includes procedures such as the Boari bladder flap. The addition of this table allows coders to more accurately represent these reconstructive procedures that were previously more difficult to classify within existing PCS tables.
Notice that the new PCS table is in the Medical and Surgical section, in the urinary body system, and addresses a Transfer procedure. Coding professionals will recall that the root operation Transfer is defined as “moving, without taking out, all or a portion of a body part to another location to take over the function of all or a portion of a body part”, which is exactly what is being done with the Boari flap. A segment of bladder is peeled back and used to form the ureteral reconstruction.
Notice that the new PCS table is in the Medical and Surgical section, in the urinary body system, and addresses a Transfer procedure. Coding professionals will recall that the root operation Transfer is defined as “moving, without taking out, all or a portion of a body part to another location to take over the function of all or a portion of a body part”, which is exactly what is being done with the Boari flap. A segment of bladder is peeled back and used to form the ureteral reconstruction.
As procedural techniques continue to evolve, coding systems must adapt to ensure accurate representation of these surgical approaches. Being aware of new tables and code options related to reconstructive urologic procedures will help coding professionals correctly capture the services performed.
Now you are In the kNOW!!
About the Author
Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.
