Amd 12 Draft 1. December 22, 2015 (effective March 1, 2016)

Transcription

1 Urogenital and Urinary Surgical ProceduresDecember 22, 2015 (effective March 1, 201) PREAMBLE - KIDNEY AND UPPER URINARY TRACT 1. No additional claim should be made for nephroscopy when done at the time of pyelolithotomy or nephrolithotomy. This does not apply to nephroscopy done in conjunction with codes listed under "Percutaneous - Procedures." 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. December 22, 2015 (effective March 1, 201) T1

2 KIDNEY AND UPPER URINARY TRACT E52 - with repeat surgery on kidney at least 30 days after previous kidney surgery...add INCISION Z01 Renal biopsy, needle S401 S402 Drainage of kidney abscess... Drainage of perinephric abscess S403 E92 S400 Exploration of renal and peri-renal tissues (with or without biopsy or unroofing of cyst)... - when performed laparoscopically, to S403...add 25% Laparoscopic placement of probe(s) for ablation of renal tumour Payment rules: This service is not eligible for payment in addition to J09. S405 Nephrolithotomy - open S408 Pyelolithotomy - open S430 Removal of staghorn calculus filling renal pelvis and calyces - open, with or without x-ray control and/or anatrophic nephrolithotomy EXCISION S410 S411 E92 Calycectomy with diversion of urine... Partial or heminephrectomy... - when performed laparoscopically, to S411...add 25% S423 Partial or heminephrectomy with total ureterectomy... Nephrectomy S412 - ectopic kidney... S413 - lumbar... E92 - when performed laparoscopically, to S413...add 25% S415 S41 E E E8 E92 - transperitoneal... - thoraco-abdominal or radical nephrectomy... - with gland dissection...add - with repair of vena cava for thrombus - below the hepatic vein...add - with repair of vena cava for thrombus - above the hepatic vein...add - when performed laparoscopically, to S41...add 25% S424 Extrophy - plastic closure of bladder with closure of abdominal wall and urethral lengthening with closure of pelvic floor with or without reimplantation of ureters S420 E92 Nephroureterectomy, total, with resection of ureterovesical junction... - when performed laparoscopically, to S420...add 25% S422 E92 E54 REPAIR Pyeloplasty (with or without nephropexy)... - when performed laparoscopically, to S422...add 25% - with removal of calculus...add S428 Symphysiotomy for horseshoe kidney with or without nephropexy and associated procedures SUTURE S429 Ruptured or lacerated kidney - repair or removal EXTRA RENAL PROCEDURES S431 S432 S433 Z30 Excision of retroperitoneal tumour... Exploration of retroperitoneal tumour... Sacrococcygeal teratoma... Extracorporeal shock wave lithotripsy T2 December 22, 2015 (effective March 1, 201)

3 KIDNEY AND UPPER URINARY TRACT PERCUTANEOUS PROCEDURES Z29 Z23 Percutaneous nephrostomy... Insertion of stent Z24 Dilatation of tract Z25 Selective catheterization of calyces (one or more) Z2 Nephroscopy, percutaneous or retrograde Z2 Removal of renal calculi E59 E2 - if disintegrated by any method, to Z2...add - percutaneous removal of staghorn calculus filling renal pelvis and extending into calyces...add Z3 Endoscopic ureterotomy or pyelotomy [Commentary: Z3 is eligible for payment when rendered by percutaneous or retrograde route.] Z3 Z00 Percutaneous ablation of calyceal diverticulum to include dilation of communication with calyx and fulguration... Change of nephrostomy tube RENAL TRANSPLANTATION PROCEDURES Submit on recipient s claim. These fees do not include immunosuppressive therapy which is on a fee-for-service basis. E2 - reconstruction or repair of renal artery done in addition torenal transplantation procedures...add S435 Kidney transplant E9 - team fee (not to be billed when assistant fees are billed)...add S434 Kidney re-transplant E1 - team fee (not to be billed when assistant fees are billed)...add S43 Donor nephrectomy - unilateral or bilateral (to include renal perfusion with hypothermia when rendered by surgeon) E53 - live donor...add E92 - when performed laparoscopically, to S43...add 25% For nephrological components - see Diagnostic and Therapeutic Procedures. S43 Renal autotransplantation Z31 Fine needle aspiration of renal transplant ENDOSCOPIC PROCEDURES S40 Cystoscopy with manipulation and/or removal of calculus and retrograde pyelogram if required Z38 Endoscopic treatment of vesicoureteral reflux by subureteral injection of agent, unilateral or bilateral Z0, Z0, Z11, Z1 and Z28 are not eligible for payment with Z38. Cystoscopy and diagnostic Ureteroscopy Z28 - above intramural E819 - diagnostic ureteroscopy of second ureter, to Z28...add 54.5 E822 - ureteroscopy to upper third of ureter or renal pelvis, to Z28...add 3.0 E0 - with removal of calculus...add 1.85 E1 - intracorporeal lithotripsy by any method...add E820 - with biopsy of one or more sites in ureter and/or pelvis using ureteroscope...add 49.5 E823 - resection and fulgarization of one or more ureteral or renal pelvic tumours, to Z28...add December 22, 2015 (effective March 1, 201) T3

4 KIDNEY AND UPPER URINARY TRACT INCISION Ureterotomy, abdominal or vaginal exploratory or for drainage With removal of calculus S445 - upper 2/3... S44 - lower 1/3... Where ureter has been previously opened S44 - upper 2/3... S448 - lower 1/ EXCISION Ureterectomy S449 - including ureterovesical junction... S450 - other e.g. partial REPAIR S452 S454 S45 E92 Ureteroileal conduit... - with ureterectomy and ileal replacement... Ureteroureterostomy... - when performed laparoscopically, to S45...add 25% Re-implantation S451 Ureterovesical anastomosis or re-implantation unilateral... Not to be billed in addition to S482. S51 S52 E92 Re-implantation of ureter with extensive tapering with or without ureterolysis... Re-implantation of bifid ureter... - when performed laparoscopically, to S451, S51 or S52...add 25% Z38 Endoscopic treatment of vesicoureteral reflux by subureteral injection of agent, unilateral or bilateral Z0, Z0, Z11, Z1 and Z28 are not eligible for payment with Z38. Ureterointestinal anastomosis S455 S42 - unilateral... - bilateral Ureterostomy Cutaneous S458 - unilateral... S43 - with lower third ureterotomy S459 Ureterovaginal fistula T4 December 22, 2015 (effective March 1, 201)

5 KIDNEY AND UPPER URINARY TRACT Ureterolysis for periureteral fibrosis S40 - unilateral E92 - when performed laparoscopically, to S40...add 25% When a physician submits a claim for performing any insured surgical procedure on the same patient on the same day as the physician submits a claim for rendering S40, the S40 service is included (in addition to the common elements) as a specific element of that other insured service. Ureteroplasty (Hutch) S41 - unilateral Bladder flap (Boari) S42 - to include re-implantation of ureter E92 - when performed laparoscopically, to S42...add 25% SUTURE Traumatic rupture, or transection (partial or complete) Immediate S45 - upper 2/ S4 - lower 1/ Late repair S4 - upper 2/ S48 - lower 1/ December 22, 2015 (effective March 1, 201) T5

6 PREAMBLE - BLADDER AND URETHRA 1. No extra claim should be made for EUA when done at the time of cystoscopy. 2. Visit fees, as applicable, to be claimed for changing a suprapubic tube. 3. No claim should be made for pre-cystoscopy dilatation of the male urethra unless urethral stricture is the primary diagnosis. No claim should be made for dilatation of the female urethra when done at the same time as cystoscopy. 4. E prefixed codes are payable in addition to any S or Z code listed under the Bladder subheading or to Z2 or Z28, unless separately noted. T December 22, 2015 (effective March 1, 201)

7 December 22, 2015 (effective March 1, 201) UROGENITAL AND URINARY SURGICAL PROCEDURES BLADDER ENDOSCOPY - CYSTOSCOPY Diagnostic and Therapeutic Procedures Z0 Diagnostic with or without urethroscopy Z0 Repeat within 30 days E5 - with catheterization of the ureter and collection of the ureteral specimen, unilateral...add E81 - with catheterization of the ureter and retrograde injection of opaque media, unilateral...add E - with unilateral brush biopsy of renal pelvis and/or ureter, and/or transurethral biopsy of bladder...add E818 - with insertion of ureteric stent, unilateral...add E - with cystometrogram (to include urethral pressure profile if necessary)...add E80 - with needle biopsy of prostate...add 32.0 E83 - with secondary surgical evacuation of bladder clots and control of haemorrhage...add 99.5 E84 - with hydrodistention of bladder - general anaesthetic...add E824 - with bladder biopsy - general anaesthetic...add E3 - with placement of ureteric stent past obstructing lesion (unilateral)...add Only one of E3 or E818 is eligible for payment for the same ureteric obstruction. 2. Time units and anaesthesia extra units listed on GP1 are not eligible for payment with anaesthesia services for Z0C or Z0C. 3. E003C is not payable for anaesthesia services rendered for Z0 or Z0. E91 - with periurethral injection of bulking agents...add 2.00 E81 - with electrocoagulation - tumour(s)...add E82 - with electrocoagulation - Hunner ulcer...add E8 - with resection or incision bladder neck, female...add 99.0 E8 - with resection or incision bladder neck, male...add E88 - with ureteral meatotomy, by any means...add 99.0 E89 - with removal foreign body or calculus...add 99.0 E90 - with removal of ureteric catheter...add 8.80 E51 - with insertion of chemotherapeutic agent(s)...add 54.0 E51 is not eligible for payment with Z02, Z03 or Z11. Excision of tumour or tumours including base and adjacent muscles and electrocoagulation, if necessary Z32 - single tumour 1 to 2 cm diameter Z33 - single tumour over 2 cm diameter Z34 - multiple tumours No additional claim for cystoscopy when done at the same time as excision of tumour(s). December 22, 2015 (effective March 1, 201) T

8 December 22, 2015 (effective March 1, 201) BLADDER INTRODUCTION Catheterization Z02 - office Z03 - home Z11 - hospital Catheterization is only eligible for payment for acute retention, change of Foley catheter or suprapubic tube or instillation of medication. 2. Z03 or Z11 is only eligible for payment when rendered personally by the physician. 3. Z11 is not eligible for payment in conjunction with any surgical procedure. Z08 Manual catheter declotting and irrigation of bladder Z10 Intravesical instillation of BCG or immunotherapeutic agent or chemotherapeutic agent for the treatment of bladder cancer Payment rules: 1. This service is only eligible for payment when the service, including the catheterization and preparation and disposal of the agents, is rendered personally by the physician. 2. Z02, Z03 or Z11 is not eligible for payment in addition to Z10. [Commentary: Z10 is not payable for indications other than bladder cancer.] INCISION Z05 S48 Z480 E50 Aspiration... Cystotomy or cystostomy... Cystotomy with trochar and cannula and insertion of tube... - when done in conjunction with another procedure...add S481 E92 Cystolithotomy - when sole operative procedure... - when performed laparoscopically, to S481...add 25% 20.5 S4 Cutaneous vesicostomy EXCISION Cystectomy - Partial S482 - partial for tumour or diverticulum (single or multiple)... S483 - with reimplantation of ureter... S490 - with reimplantation of ureters... E92 - when performed laparoscopically, to S482, S483 or S490...add 25% S482 not to be billed in addition to S451. T8 December 22, 2015 (effective March 1, 201)

9 BLADDER UROGENITAL AND URINARY SURGICAL PROCEDURES Cystectomy - Complete S484 - complete cystectomy, without transplant... S485 - with ureterointestinal transplant... S453 - with ureteroileal conduit... S440 - with continent urinary diversion... E92 - when performed laparoscopically, to S484, S485, S453 or S440...add 25% S438 Retroperitoneal lymph node dissection for bladder cancer, specimen must include obturator, internal iliac and external iliac nodes as a minimum to the level of the iliac bifurcation, bilateral S441 Creation of continent urinary diversion S41 E92 Excision of urachal cyst or sinus with or without umbilical hernia repair... - when performed laparoscopically, to S41...add 25% Extrophy - excision of bladder and repair of abdominal wall S488 - inclusive of graft S491 Plastic repair of extrophy using bladder and including skin flaps REPAIR S512 S513 Repair of ruptured bladder... Cystoplasty, using intestine Plastic repair of bladder neck S518 S519 - child... - adolescent or adult S521 E92 DESTRUCTION Litholapaxy and removal of fragments... - when performed laparoscopically, to S521...add 25% SUTURE Closure of fistula S522 External, suprapubic... Vesicovaginal S523 - vaginal approach... S524 - transvesical approach (with or without omental flap)... S525 Vesicorectal or vesicosigmoid... E92 - when performed laparoscopically, to S522, S524 or S525...add 25% Closure of fistula - see also Operations on the Female Genital System, page V4. December 22, 2015 (effective March 1, 201) T9

10 URETHRA UROGENITAL AND URINARY SURGICAL PROCEDURES ENDOSCOPY Urethroscopy Z1 - diagnostic Z18 - with biopsy....0 S54 Removal of foreign body or calculus INCISION Z1 Biopsy of urethra (without endoscopy) Urethrotomy S530 - external S532 - transurethral (visual) S538 - repeat procedure within months by same surgeon S531 Urethrostomy Z04 Meatotomy and plastic repair Z09 Periurethral abscess EXCISION S53 Caruncle S53 Urethral papilloma, single or multiple S541 Diverticulectomy - male or female S542 Posterior urethral valve S543 Prolapse urethra S544 Urethrectomy - radical REPAIR S548 Urethral sling S815 Tension free vaginal tape mid-urethral sling, by any method/approach Payment rules: Cystoscopy (Z0) is not eligible for payment with S815 or S548 unless the cystoscopy is rendered for suspicion of disease. Retropubic urethropexy for stress incontinence S549 - primary procedure S54 - repeat procedure for failed retropubic or vaginal surgery for stress incontinence E82 - when performed laparoscopically, to S549 or S54...add 25% See also procedures for stress incontinence in Female Genital Surgical Procedures. S539 Insertion of artificial urinary sphincter....0 S540 Revision or removal of artificial urinary sphincter T10 December 22, 2015 (effective March 1, 201)

11 URETHRA UROGENITAL AND URINARY SURGICAL PROCEDURES Urethroplasty First stage S545 - posterior S550 - anterior S558 Second stage S535 One stage repair and may include skin grafting SUTURE S551 Rupture, anterior urethra (diversion of urine extra) Z12 Endoscopic urethral realignment for urethral trauma Payment rules: Cystoscopy, urethroscopy, retrograde urethrogram or insertion of guidewire/catheter is not eligible for payment with Z12. Posterior urethra S552 - immediate repair S553 - late repair Fistula S554 - penile urethra (diversion of urine extra) S555 - perineal urethra S55 Rectourethral with diversion, colostomy and closure of colostomy DESTRUCTION S55 Urethrovesicolysis - when sole operative procedure S54 Transurethral incision or resection of external sphincter - when sole operative procedure MANIPULATION Dilatation of stricture Z21 - male, local anaesthetic Z19 - male, general anaesthetic Dilatation of urethra Z22 - female Z20 - female, general anaesthetic Z15 Filiform and follower urethral dilation and may include bladder catheterization Z19, Z20, Z21, Z22 payable at nil if claimed with Z15. December 22, 2015 (effective March 1, 201) T11

12 NOT ALLOCATED T12 December 22, 2015 (effective March 1, 201)