April SURGICAL PROCEDURES OPERATIONS ON THE UROGENITAL SYSTEM Code by lisaturtle

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									                                                                                                                          April 1, 2009

                                                         SURGICAL PROCEDURES

                                        OPERATIONS ON THE UROGENITAL SYSTEM

                                                                                                                         Spec.   G.P.
Code                                                                                           G.P.   Assist    Spec.    Anaes. Anaes.



        KIDNEYS AND PERINEPHRUM

1.      No additional claim should be made for nephroscopy
        when done at the time of pyelolithotomy or
        nephrolithotomy.

2.      In a routine surgical approach to the kidney and related
        procedures, no additional claim should be made for rib
        resection carried out for access purposes.

3.      When an adrenalectomy is performed in conjunction with
        a nephrectomy and is incidental to the removal of the
        kidney, there should be no additional claim for the
        adrenalectomy.

        Percutaneous Procedures (IOP)
96802   Percutaneous nephrostomy ...............................................                                144.79
96804   Insertion of stent ................................................................                     103.35
96806   Dilation of tract...................................................................                    129.26
96808   Selective catheterization of calyces ...................................                                 70.99
96810   Nephroscopy......................................................................                       129.26
96812   Removal of renal calculi.....................................................                   40.85   226.16     6       6
96814       - if disintegrated by ultrasound ...............................add                                 129.26

        Incision
96820   Renal biopsy, needle (IOP)................................................                               83.41     4       4
96822   Drainage of kidney abscess...............................................                       57.19   213.64     7       7
96824   Drainage of perinephric abscess .......................................                         57.19   128.62     7       7
96826   Exploration of renal and perirenal tissues with or without
           biopsy or unroofing of cyst............................................                      57.19   207.10     7       7
        Nephrotomy
96828      - with drainage - nephrostomy ......................................                         57.19   207.10     7       7
96832      - with removal of calculus .............................................                     57.19   272.50     7       7
96836   Transection of aberrant renal vessels ................................                          57.19   226.72     7       7
96838   Pyelotomy - with drainage ................................................                      57.19   213.64     7       7
96840                - with removal of calculus ...............................                         57.19   256.15     7       7
96842                - with diversion of urine...................................                       57.19   259.42     7       7

        Excision
96850   Calycectomy with diversion of urine...................................                          57.19   432.00     7       7
96852   Hemi-nephrectomy ............................................................                   57.19   470.47     7       7
96854   Partial or hemi-nephrectomy with total ureterectomy.........                                    57.19   487.10     7       7
        Nephrectomy
96860      - simple.........................................................................            57.19   467.00     7       7
96865      - thoraco-abdominal or radical nephrectomy with
              or without gland dissection....................................                          106.21   875.00     13     13
96868      - partial nephrectomy for malignancy............................                            106.21   697.95     13     13
96872   Nephro-ureterectomy, total, without resection of
           ureterovesical junction..................................................                    57.19   305.20     10     10
96874   Nephro-ureterectomy,              total,        with         resection            of
           ureterovesical junction.................................................                     57.19   329.18     10     10
96876   Excision of stenosed renal artery with reimplantation or
           homograft .....................................................................              57.19   414.20     15     15




                                                                             R-1
                                                                                                                          April 1, 2009

                                                        SURGICAL PROCEDURES

                                        OPERATIONS ON THE UROGENITAL SYSTEM

                                                                                                                         Spec.   G.P.
Code                                                                                          G.P.   Assist    Spec.     Anaes. Anaes.



        KIDNEYS AND PERINEPHRUM (Cont’d)

        Repair
96880   Pyeloplasty........................................................................            57.19    376.20     7       7
96884   Nephropexy ...................................................................                 57.19    226.72     7       7
96886   Renal sympathectomy.......................................................                     57.19    257.24     7       7
96888   Symphysiotomy, for horseshoe kidney with or without
           nephropexy and associated procedures. .....................                                 57.19    259.42     7       7

        Suture
96894   Ruptured or lacerated kidney - repair or removal ..............                                57.19    257.24     7       7

        Litholapaxy
96900   Staghorn (pelvic) with lithotripsy under x-ray control.........                                57.19    381.50     9       9

        Extra Renal Procedures
96910   Excision of retroperitoneal tumour.....................................                        57.19    226.72     7       7
96912   Exploration of retroperitoneal tumour ................................                         57.19    178.22     7       7
96914   Sacro-coccygeal teratoma.................................................                      49.02    259.42     6       6
96916   Renal hypothermia - extra .................................................                              32.70

        Extracorporeal Shock Wave Lithotripsy (IOP)
96918      - unilateral, any mode, per session, per patient ...........                                         313.19     6       6
96920      - bilateral, any mode, per session, per patient .............                                        558.00     6       6

        Kidney Transplants
96940   Kidney transplant (team fees, these fees do not include
           immunosuppressive therapy, which is on a fee-for-
           service basis ................................................................                       555.90     13     13
96944   Donor nephrectomy (extra) team fee, uni or bilateral ........                                  57.19   1050.00     16     16
96948   Renal autotransplantation .................................................                             467.61     10     10




                                                                            R-2
                                                                                                                            April 1, 2009

                                                           SURGICAL PROCEDURES

                                         OPERATIONS ON THE UROGENITAL SYSTEM

                                                                                                                           Spec.   G.P.
Code                                                                                             G.P.   Assist    Spec.    Anaes. Anaes.



        URETER

        Incision
96970   Peri-ureteral abscess .........................................................                   49.02   130.80     6       6
        Ureterotomy, abdominal or vaginal exploratory or for
            drainage
96972       - upper 2/3 ....................................................................              49.02   163.50     6       6
96974       - lower 1/3.....................................................................              49.02   226.72     6       6
        with removal of calculus
96976       - upper 2/3 ....................................................................              49.02   218.00     6       6
96978       - lower 1/3.....................................................................              49.02   277.95     6       6
        where ureter has been previously opened
96980       - upper 2/3 ....................................................................              49.02   244.16     6       6
96982       - lower 1/3.....................................................................              49.02   289.94     6       6

        Excision
        Ureterectomy
96990      - including ureterovesical junction ................................                           57.19   285.28     7       7
96992      - other ...........................................................................            57.19   211.48     7       7

        Repair
97000   Trimming of ureter .............................................................                  49.02   257.24     6      6
97002   Uretero-vesical anastomosis or reimplantation - unilateral                                        49.02   461.40     8      8
97004   Bifid ureter .........................................................................            49.02   272.50     8      8
97006   Uretero-ileal conduit...........................................................                  49.02   457.80     9      9
97008   Uretero-ileal conduit with total cystectomy.........................                              49.02   512.06     15     15
97010   Uretero-ileal conduit with ureterectomy and ileal
            replacement..................................................................                 49.02   453.44     7       7
97012   Uretero-intestinal anastomosis or transplant - unilateral                                         49.02   194.02     6       6
97018   Uretero-ureterostomy.........................................................                     49.02   352.87     8       8
97020   Ureterostomy, cutaneous, unilateral ..................................                            49.02   161.32     6       6
97024   Uretero-vaginal fistula........................................................                   49.02   327.00     6       6
97026   Ureterolysis for periureteral fibrosis - unilateral..................                             49.02   257.24     6       6
97028   Ureteroplasty (Hutch), unilateral ........................................                        49.02   194.02     6       6
97030   Bladder flap (Baori)............................................................                  49.02   261.60     6       6

        Suture
        Spontaneous/traumatic rupture or transection
97040      - immediate - upper 2/3 ...............................................                        49.02   226.72     6       6
97042                    - lower 1/3................................................                      49.02   257.24     6       6
97044      - late repair - upper 2/3 ...............................................                      49.02   257.24     6       6
97046                    - lower 1/3................................................                      49.02   292.14     7       7

        Endoscopic Procedures
97050   Calibration and/or dilation - 1 or both sides........................                                     166.26     4       4
        Manipulation and/or removal of calculus including ureteral
97052
            meatotomy if required...................................................                              166.26     4       4
        Cystoscopy and diagnostic ureteroscopy above
97054   Intramural ureter (IOP).......................................................                            169.32     4       4
97056       - with removal of calculus .......................................add                                 226.16
97058       - if disintegrated by ultrasound ...............................add                                   129.26




                                                                               R-3
                                                                                                                               April 1, 2009

                                                            SURGICAL PROCEDURES

                                          OPERATIONS ON THE UROGENITAL SYSTEM

                                                                                                                              Spec.   G.P.
Code                                                                                              G.P.     Assist    Spec.    Anaes. Anaes.



        BLADDER

        Endoscopy-Cystoscopy

        Diagnostic Procedures, includes dilation for access
           (IOP)
        Note: Includes catheterization of ureters with or without
                collection or ureteral specimens, intravenous
                function test and retrograde injection of opaque
                media and/or manometry and/or meatotomy.
97070   Cystoscopy with or without urethroscopy ..........................                         86.09              95.66     4       4
97072   Repeat within 30 days .......................................................              43.05              47.83     4       4
97078   With transurethral biopsy, brush biopsy of renal pelvis
           and/or ureter and/or insertion of ureteral stent....... add                                                33.54
97080   With retrograde pyelogram.......................................... add                                       20.68
97088   With needle biopsy of prostate .................................... add                                       43.91

        Therapeutic Procedures
        (payable with, add-on to code 97070)
97090   With electrocoagulation of tumour............................... add                                          67.21
97092   With electrocoagulation of ulcer .................................. add                                       67.21
        With excision of tumour or tumours including base and
           adjacent muscles and electrocoagulation if necessary
97096      - single tumour 1-2 cm. diameter ........................... add                                          107.32
97098      - single tumour over 2 cm. diameter....................... add                                            216.32
97100      - multiple tumours .................................................. add                                 216.32
97102   With resection bladder neck - female ....................... add                                             134.35
97104                                      - male .......................... add                                     350.88     1       1
97106   With electro-surgical ureteral meatotomy .................... add                                            134.35
97108   With removal of foreign body or calculus..................... add                                            134.35

        Introduction (IOP)
        Catheterization
97120       - office ..........................................................................     5.89               6.54
97122       - home..........................................................................        8.34               9.27
            - hospital ......................................................................      VF                 VF
97126   Intravesicular chemotherapy .............................................                   9.81              10.90

        Incision
97130   Aspiration (IOP).................................................................                             13.08
97132   Cystotomy with trochar or cannula and insertion of tube...                                 57.88              64.31     5       5
97136   Incisional cystotomy or cystostomy ...................................                               40.85   135.16     5       5
97138   Incisional cystotomy or cystostomy and electrocoagulation
            of tumour......................................................................                  40.85   194.02     5       5
97140   Cystolithotomy...................................................................                    40.85   162.40     5       5
97142   Cutaneous vesicostomy ....................................................                           40.85   231.08     5       5
97144   Reduction cystoplasty (bladder plication) ..........................                                 40.85   189.66     5       5




                                                                                 R-4
                                                                                                                             April 1, 2009

                                                           SURGICAL PROCEDURES

                                         OPERATIONS ON THE UROGENITAL SYSTEM

                                                                                                                            Spec.   G.P.
Code                                                                                             G.P.   Assist    Spec.     Anaes. Anaes.



        BLADDER (Cont’d)

        Excision
        Cystectomy
97150   Partial for tumour or diverticulum (single or multiple).........                                  49.02    249.50      6      6
97152      - with reimplantation of ureter .......................................                        49.02    322.64      7      7
97154      - with reimplantation of ureters .....................................                         49.02    354.25      7      7
97156   Complete cystectomy, without transplant...........................                                49.02    259.42     10     10
97160      - with uretero-ileal conduit ............................................                      65.36   1050.00     15     15
97162   Complete cystectomy with Koch pouch urinary diversion ..                                          73.53   1432.45     15     15
97164   Excision of urachal cyst or sinus with or without umbilical
           hernia repair .................................................................                49.02    155.87     6       6
97166   Excision of urachus, repair of bladder and diversion of
           urine .............................................................................            49.02   161.32      6       6
        Extrophy
97168      - excision of bladder and repair of abdominal wall,
              inclusive of graft .......................................................                  49.02    113.36     6       6
97174      - plastic repair of extrophy using bladder and including
              skin flaps ...................................................................              49.02    388.04     6       6

        Repair
97228   Urinary diversion procedure using intestine, without
           cystectomy ...................................................................                 73.53    983.75     15     15
97230   Repair of ruptured bladder .................................................                      40.85    194.02      6      6
97232   Cystoplasty, using intestine ...............................................                      40.85    388.04      9      9
97234   Suprapubic sphincterectomy for Marion’s disease.............                                      40.85    194.02      5      5
        Plastic repair of bladder neck
97236      - child............................................................................            40.85    194.02     5       5
97238      - adult or adolescent.....................................................                     40.85    259.42     5       5
97240      - with diverticulectomy ..................................................                     40.85    316.10     7       7

        Destruction
97250   Litholapaxy, visual or tactile and removal of fragments......                                     40.85    128.62     4       4

        Suture
        Closure of fistula
97260   External, suprapubic ..........................................................                   32.68    161.32     4       4
97262   Vesico-vaginal - vaginal approach...................................                              32.68    234.35     6       6
97264                     - trans-vesical approach ..........................                             40.85    250.70     6       6
97266   Vesico-rectal or vesicosigmoid ..........................................                         40.85    239.80     6       6




                                                                               R-5
                                                                                                                          April 1, 2009

                                                          SURGICAL PROCEDURES

                                         OPERATIONS ON THE UROGENITAL SYSTEM

                                                                                                                         Spec.   G.P.
Code                                                                                           G.P.   Assist    Spec.    Anaes. Anaes.



        URETHRA

        Incision
97280   Biopsy of urethra without endoscopy (IOP) .......................                                        13.08     4       4
97282   Urethrotomy, external........................................................                   24.51   128.62     4       4
97288   Urethrostomy ...................................................................                24.51   128.62     4       4
97290   Meatotomy and plastic repair ............................................                                29.43     4       4
97296   Peri-urethral abscess - complete care...............................                                     32.70     4       4

        Excision
97300   Caruncle............................................................................            24.51    65.40     4       4
97302   Urethral papilloma, single or multiple ................................                                  65.40     4       4
        Stricture, including diversion
97304       - 1 stage.......................................................................            24.51   226.72     4       4
97306       - 2 stage - first stage..................................................                   24.51   128.62     4       4
97308                   - second stage............................................                      24.51   194.02     4       4
97310   Diverticulectomy - male or female .....................................                                 161.32     4       4
97312   Posterior urethral valve .....................................................                  32.68   161.32     4       4
97314   Prolapse urethra, excision.................................................                              59.95     4       4
97316   Urethrectomy - radical .......................................................                  32.68   113.36     4       4

        Endoscopy
97320   Urethroscopy - diagnostic (IOP) .......................................                                  19.62     4       4
97322                  - with biopsy (IOP)......................................                                 45.78     4       4
97324   Internal urethrotomy ..........................................................                          64.31     4       4
97326   Removal of foreign body or calculus .................................                                    98.10     4       4

        Repair
97330   Urethral sling .....................................................................            24.51   282.04     4       4
97332   Marshall Marchetti.............................................................                 40.85   293.82     5       5
97334   Insertion of artificial urinary sphincter ................................                      32.68   714.60     6       6
                                st
        Urethroplasty - 1 stage
97336                              - posterior ........................................                 32.68   200.56     6       6
97338                              - anterior ..........................................                32.68   151.51     4       4
                                nd
97340                       - 2 stage ...............................................                   32.68   120.99     4       4
97342   One stage repair (to include skin graft if necessary) .........                                 32.68   200.56     6       6
97344   Kauffman type procedures for urinary incontinence ..........                                    24.51   200.56     5       5
97346      - where perineum has been previously operated on for
                incontinence..........................................................                  24.51   231.08     5       5
97348      - removal of perineal incontinence prosthesis..............                                  24.51    75.21     5       5

        Suture
97360   Rupture, anterior urethra (diversion of urine, extra) ..........                                32.68    97.01     4       4
97362   Posterior urethra - immediate repair ...............................                            32.68   257.24     4       4
97364                        - late repair ..........................................                   32.68   322.64     5       5
        Fistula
97366       - penile urethra (diversion of urine, extra) ....................                                    64.31     4       4
97368       - perineal urethra..........................................................                32.68   194.02     4       4
97370       - recto-urethral with diversion, colostomy and closure
                 of colostomy..........................................................                 49.02   322.64     7       7




                                                                              R-6
                                                                                                                        April 1, 2009

                                                       SURGICAL PROCEDURES

                                       OPERATIONS ON THE UROGENITAL SYSTEM

                                                                                                                       Spec.   G.P.
Code                                                                                       G.P.     Assist    Spec.    Anaes. Anaes.



        URETHRA (Cont’d)

        Destruction
97380   Urethro-vesicolysis ............................................................              24.51   128.62     4       4
97382   Transurethral incision or resection of external sphincter
           (when sole operative procedure) ..................................                                 174.40     4       4

        Manipulation (IOP)
        Dilation of stricture, male
97390       - local anaesthetic ........................................................    12.75              14.17
97392       - general anaesthetic ....................................................                         32.70     4       4
97394   Dilation of urethra, female..................................................        5.89               6.54
97396       - general anaesthetic ....................................................                         21.80     4       4




                                                                          R-7

								
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