Male Genital Surgical ProceduresDecember 22, 2015 (effective March 1, 201) PENIS Slit of prepuce (complete care) S5 - newborn... 14.35 S58 - infant... 21.50 S59 - adult or child... 30.25 EXCISION Circumcision - for physical symptomatology only S53 - for patients aged one year or older... 19.40 S5 - for infants less than one year of age... 90.05 1. Circumcision is an insured service only when medically necessary. As such, circumcision performed for ritual, cultural, religious or cosmetic reasons at any age is not an insured service. 2. Circumcision for neonatal phimosis is not an insured service. Z02 Biopsy... 23.55 E542 - when performed outside of hospital...add 11.15 Amputation S54 S55 S5 - partial... - partial with inguinal glands 1 or 2 stages... - radical with inguinal and femoral glands 1 or 2 stages... 10.5 43.20 552.30 Condylomata Z01 - local anaesthetic... 32.0 Z S599 - general anaesthetic... Excision plaque for Peyronies disease... 8.0 210.95 Where grafting is necessary, appropriate skin graft fee is payable with S599. REPAIR Hypospadias or Epispadia One stage repair S58 - with meatus to but not into glans... S51 - with advancement of meatus into glans... S52 - into glans using island flap pedicle (penoscrotal)... 28.5 383.50 2.45 S59 S580 S581 Chordee repair... Plastic reconstruction, urethra... Closure urethro-cutaneous fistula... 215.80 331.0 92.10 S59 E55 Penile prosthesis for impotence... - with inflatable prosthesis...add 30.85 55.15 S588 S5 Surgical removal of prosthesis... Revision including removal of prosthesis... 110.15 239.5 Z00 Intracorporeal injection for impotence... 2.80 December 22, 2015 (effective March 1, 201) U1
TESTIS Z03 Abscess... 55.15 Z04 Z05 Z0 BIOPSY Single... Bilateral... - with vasography... 55.15 83.35 120.80 See also Diagnostic Radiology - GU Tract. Orchidectomy S589 - unilateral... 10.5 Radical orchidectomy for malignancy S598 - unilateral... 235.35 S590 E92 Retroperitoneal lymph node dissecton (RPLND) for testicular tumour... - when performed laparoscopically, to S590...add 25% 834.25 8 REPAIR Orchidopexy S591 - for undescended testis, any type, one or two stages to include hernia repair where required... 331.0 S593 E92 Exploration for undescended testicle, without orchidopexy... - when performed laparoscopically, to S591 or S593...add 25% 20.85 S00 S595 S59 Reduction of torsion of testis or appendix testis and orchidopexy (one or both sides) if required... Ruptured testicle... Insertion of testicular prosthesis... Insertion of testicular prosthesis performed at the time of orchidectomy is not eligible for payment. [Commentary: See Appendix D - Sub-Surface Pathology under Congenital Deformities and Post-Traumatic Deformities.] 235.35 10.5 10.5 U2 December 22, 2015 (effective March 1, 201)
EPIDIDYMIS AND TUNICA VAGINALIS EPIDIDYMIS Z0 Incision of abscess... 55.15 S01 Spermatocele or spermatic granuloma excision... 205.35 Epididymectomy S02 - unilateral... 10.5 TUNICA VAGINALIS Z08 Hydrocele aspiration... 1.25 S11 Hydrocele excision - unilateral... 205.35 Hydrocele excision rendered with hernia repair is claimed as E2. December 22, 2015 (effective March 1, 201) U3
SCROTUM Z09 Z8 S1 Abscess or haematocele - local anaesthetic... - general anaesthetic... - and exploration - unilateral... 20.10 55.15 85.30 EXCISION S18 Resection of scrotum... 215.80 SUTURE For suture of lacerations, refer to the general listings under Integumentary System Surgical Procedures - Skin and Subcutaneous Tissue - Suture of Lacerations. Where suture of lacerations is the sole procedure and is done under general anaesthesia, refer to code E530. U4 December 22, 2015 (effective March 1, 201)
VAS DEFERENS Z10 Vasography... 55.15 REPAIR Vasovasostomy and/or vasoepididymostomy S23 - unilateral... S25 - including biopsy and vasography... 215.80 20.85 To include microscopic control if required. SUTURE Vasectomy S2 - uni - or bilateral - by any technique... nil 10.40 E545 - when performed outside hospital...add 11.15 Vasectomy reversal is an insured benefit only for treatment of significant symptomatology, and requires prior approval. Reestablishing fertility does not constitute significant symptomatology. December 22, 2015 (effective March 1, 201) U5
SPERMATIC CORD AND SEMINAL VESICLES SPERMATIC CORD Hydrocele excision S30 - single... 205.35 Varicocele excision S31 - single... S30 when done with hernia repair use E2. 205.35 SEMINAL VESICLES Z11 Incision of abscess... 120.80 S3 Vesiculectomy... 552.30 U December 22, 2015 (effective March 1, 201)
PROSTATE PREAMBLE A transurethral resection followed within 10 days by a bilateral orchidectomy because of carcinoma of the prostate should be claimed in accordance with paragraph (3) of the Surgical Preamble (SP2.). Z12 Z13 S44 Biopsy, needle... - with drainage abscess... Biopsy, perineal, open operation... 85.45 92.10 215.80 EXCISION Prostatectomy S45 Perineal... 54.0 S4 S4 Perineal with vesiculectomy... Suprapubic - with or without removal of bladder stones... 8 85.00 00.5 11 Retropubic - with or without removal of bladder stones S50 - simple... S51 - radical... E92 - when performed laparoscopically, to S4, S50 or S51...add 25% 00.5 1008.35 1. Prostatectomy (S45-S51) does not include investigative cystoscopy but includes vasectomy when rendered. 2. S51 includes S519 - plastic repair of bladder neck when rendered and/or S3 - vesiculectomy when rendered. S52 Staging pelvic lymphadenectomy for prostatic cancer (laparoscopic or open) must include at a minimum bilateral obturator nodes... 431.20 10 E92 - when performed laparoscopically, to S52...add 25% [Commentary: A sampling of nodes does not constitute a complete staging lymphadenectomy. When only a sampling of nodes is performed, either S312 - laparotomy or Z553 - laparoscopic biopsy, may be eligible for payment depending on procedure performed.] S53 Laparoscopic radical prostatectomy... 8 1411.0 10 ENDOSCOPY Transurethral resection of prostate S55 - and may include cystoscopy, meatotomy, dilatation of stricture, internal urethrotomy or vasectomy... 450.0 S54 - for residual or regrowth of tissue within one year of previous prostatectomy by same surgeon... 411.20 S5 - Transurethral drainage of abscess... 85.30 10 December 22, 2015 (effective March 1, 201) U
NOT ALLOCATED U8 December 22, 2015 (effective March 1, 201)