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 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 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 of stenosed renal artery with reimplantation or homograft... 57.19 414.20 15 15 R-1
KIDNEYS AND PERINEPHRUM (Cont d) 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 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 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-forservice 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
URETER 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 Ureterectomy 96990 - including ureterovesical junction... 57.19 285.28 7 7 96992 - other... 57.19 211.48 7 7 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 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... 49.02 292.12 7 7 Endoscopic Procedures 97050 Calibration and/or dilation - 1 or both sides... 166.26 4 4 97052 Manipulation and/or removal of calculus including ureteral 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
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 97130 Aspiration (IOP)... 13.08 97132 Cystotomy with trochar or cannula and insertion of tube... 57.88 64.31 5 5 97136 al cystotomy or cystostomy... 40.85 135.16 5 5 97138 al 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
BLADDER (Cont d) 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 of urachal cyst or sinus with or without umbilical hernia repair... 49.02 155.87 6 6 97166 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 97228 Urinary diversion procedure using intestine, without cystectomy... 73.53 983.75 15 15 97230 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 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
URETHRA 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 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 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 Urethroplasty - 1 st stage 97336 - posterior... 32.68 200.56 6 6 97338 - anterior... 32.68 151.51 4 4 97340-2 nd 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 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
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