Urinary system

Anatomic divisions  Laparoscopy 50541-50549

- Kidney  Ablation of renal cyst
- ureters  Nephrectomy
- bladder  Endoscopy 50551-50580
- urethra  through an established nephrostomy
procedures on prostate in either urinary or male  through an established nephrotomy
genital system
 Lithotripsy 50590
Kidney treatment using ultrasound shock waves, by
 Incision which kidney stone is broken into small particles
 renal exploration 50010 that can be passed out by the body.
 Drainage of periranal or renal abscess ESWL- Extracorporeal Shockwave Lithotripsy
50020  Renal Transplant 50300-50380
 Nephrostomy 50040 Backbench work
an artificial opening created between the o Retrieval of organ
kidney and skin which allows for the urinary o Deceased 50300
diversion o Living 50320, open; 50547 laparoscopy
 Nephrotomy 50045 Preparation of organ
the physician makes a small incision in the o Deceased 50323
kidney to explore the interior of the kidney o Living 50325
 Nephrolithotomy 50060-50075 Transplantation
the physician removes a kidney stone o w/o nephrectomy 50360
(calculus) by making an incision in the kidney
o W/ nephrectomy 50365
 Percutaneous nephrostolithotomy
o add modifier -50 for bilateral procedure
50080-50081
Ureter
the physician creates a percutaneous
 Incision
passageway to remove kidney stones(calculi).
The physician inserts an endoscope over the o Ureterotomy 50600-50605
guidewire and passes an instrument through the physician makes an incision in the ureter
the endoscope to crush or extract calculi (ureterotomy) for examination of the ureter
 Pyelotomy 50120-50135 or insertion of a drainage catheter
the physician makes an incision in the renal (ureterostomy tube) between the ureter and
pelvis to explore the calyces and renal pelvis skin
o Ureterolothotomy 50610-50630
 Excision
the physician makes an incision in the ureter
 Biopsy 50200-50205
(ureterotomy) to remove a stone (calculus)
 Percutaneous- trocar/needle
from the ureter
 Surgical exposure
 Excision
 Nephrectomy 50220-50240
o Uterectomy 50650-50660
open procedure
 Ablation of renal mass 50250  Repair
o Ureteroplasty 50700
 Cyst 50280-50290
 Repair  Laparoscopy
o 50945
 Pyeloplasty 50400-50405
the physician uses plastic surgery to correct an o the physician performs a laparoscopic
obstruction or defect in the renal pelvis or surgical removal of a stone (calculus)
ureteropelvic junction lodged in the ureter (ureterolithotomy)
 Endoscopy 2cm= 52234
o through an established ureterostomy 2. Multiple bladder tumors
o through an established ureterotomy 1.5 cm
Bladder 2.5 cm
 Many bundled codes 6 cm
Example: - code only the largest tumor
o urethral dilation is included with Urethra
insertion of cystoscope  Excision 53200-53275
o Read all descriptions carefully for site,  53210- Female
technique, and reason for procedure  53215- male
 Incision  Repair 53400-53520
o Cystotomy  Urethroplasty may be one or two stage
o Cystostomy 51040- the physician  some codes divided based on male/female
creates an opening in to the bladder - Manipulation 53600-53665
(cystostomy) through an incision in the  Stretches of narrowed passage
bladder (cystotomy)
o Cystolithotomy 51050- the physician
makes an incision in the bladder to
remove a calculus
 Removal 51100-51102
Aspiration of fluids in the bladder
o needle
o trocat or intracatheter
o with insertion of suprapubic catheter
 Introduction
o Insertion of catheter 51701-51703
 Laparoscopy
o Sling operation 51992
 Endoscopy
o Cystoscopy
o Urethroscopy
o Cystourethroscopy
 Endoscopy- Urethra and bladder
o Cystourethroscopy 52204-52305
 Endoscopy- ureter and pelvis
o Cystourethroscopy 52320-52343
o Cystourethroscopy, with ureteroscopy
52344-52355
 Endoscopy- Vesical neck and prostate
o Cystourethroscopy
o TURP 52601- transurethral resection of
prostate
Example:
1. Cystourethroscopy resection of bladder
tumor
Male Genital System
Anatomic Subsection: Testis
- Penis  Excision (54500-54535)
- Testis o Biopsy: Incisional or needle 54500-
- Epididymis 54505
- Tunica Vaginalis o Excision of lesion
- Scrotum o Orchiectomy codes reported by:
- Vas deferens  Simple or radical
- Spermatic cord  Unilateral or bilateral
- Seminal vesicles  with or without testicular
- Prostate prosthesis insertion
Penis  Approach- inguinal/abdominal
 Incision 5400-54015  Exploration 54550-54560
 Sitting of prepuce o undescended testis- is a testicle that
the physician makes a cut or slit in the prepuce hasn’t moved into its proper position
to relieve a constriction that prevents the in the bag of skin hanging below the
retraction of the foreskin back over the head of penis (scrotum) before birth
the penis  Repair
 Destruction 54055-54065 o Orchiopexy- moving and fixation of
 Chemical testis to scrotal sac
 Electrodessication  open or laparoscopic
 Laser surgery  inguinal or abdominal approach
 surgical excision  if bilateral, use -50
o Excision  many times, the undescended
 Circumcision 54150-54161 testis is associated with a hernia
codes dependent on the age of the patient Epididymis
o clamp  I&D abscess or hematoma 54700
o surgical excision  Excision 54800-54861
 Introduction o Biopsy
- injection for Peyronie's disease 54200 o Lesion or spermatocele (cyst)
- a non-cancerous condition resulting  Exploration 54865
from fibrous scar tissue that develops  Repair 54900, 54901
on the penis and causes curved, painful o Epididymovasostomy
erections o Report operation microscope
- Surgical excision of plaque 54110 separately 69990
- Priapism 54220- prolonged erection of Tunica Vaginalis 5500-55060
the penis  Incision 55000
 Repair  Excision 55040-55041
 Chordee- condition in which the head of o Hydrocele (fluid collection)
the penis curves downward or upward, at (unilateral or bilateral)
the junction of the head and shaft of the  Repair: Bottle type repair 55060
penis
Scrotum 55100-55180
 Hypospadias- the opening of the urethra is  Incision 55100-55120
not located at the tip of the penis
 Excision 55150
 Epispadias- the urethra opens in top of the
 Repair
penis rather than the tip
 o Scrotoplasty- the physician repairs
defects and developmental
abnormalities of the scrotum by wound
revisions or the creation and suturing of
simple scrotal skin flaps
 55175- simple scrotal skin flaps
 55180-complicated:the
reconstruction is more complex
and the physician uses free skin
grafts, mesh grafts, and/ or the
extensive use of rotational pedicle
grafts from adjacent skin
Vas Deferens 55200-55400
 Incision: Vasotomy to collect sperm
sample or identify obstruction
 Excision: Vasectomy for sterilizarion
procedure
o A post operative semen examination is
included
o Do not use -50
 Introduction: Dye for radiographic
procedure
 Repair: the physician treats a blockage
o operating microscope: 69990
Spermatic Cord 55500-55559
 Hydrocele: 55500 with modifier -50
bilateral
 Varicocele: Trapped blood causes vessel to
swell, for excision
o Scrotal approach: 55530
o Abdominal approach: 55535
o Laparoscopy: 55550
o Excision of varicocele and hernia
repair: 55540
Seminal Vesicle 55600-55680
 Incision: Vesiculotomy
o Simple: 55600
o complicated: 55605
 Excision: Vesiculectomy
o For removal of tumor, calculus, or other
obstruction
o 55650, any approach
o add -50 for bilateral
Prostate
 Incision
 Biopsy
o Needle or punch 55700
o Needle, transperineal, stereotactic, 55706
o Incisional 55705
 Prostatomy- cutting or puncturing the
prostate
 55720- for simple drainage
 55725- if the procedure is complicated by
excessive bleeding, infection, or other
problem
Prostatectomy
 Open 55801-55845
 Laparoscopic- 55866
Reproductive System Procedures 55920
 Reports placement of catheters/ needles
into pelvic organs/ genitalia or subsequent
interstitial radioelement application
 the physician places needles or catheters
into the pelvic organs and/or genitalia,
excluding the prostate, for subsequent
interstitial radioelement application. The
radioactive isotopes that are introduced
subsequently, such as iodine-125 or
palladium 103, are contained within tiny
seeds that are left in place to deliver
radiation over a period of months
Intersex Surgery 55970-55980
 There are only 2 codes within subsection:
o Male to female
o Female to male
 Complicated procedures completed over
extended period of time
 Performed by multiple physicians with
extensive specialized training