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CHAPTER 19

CHAPTER 19. URINARY AND MALE GENITAL SYSTEMS. Urinary System. Anatomic divisions Kidney Ureters Bladder Urethra Procedures on prostate in either Urinary or Male Genital System (Cont’d…). Figure: 19.1. Urinary System. (…Cont’d) Further divided by procedure Incision Excision.

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CHAPTER 19

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  1. CHAPTER 19 URINARY AND MALE GENITAL SYSTEMS

  2. Urinary System Anatomic divisions Kidney Ureters Bladder Urethra Procedures on prostate in either Urinary or Male Genital System (Cont’d…) Figure: 19.1

  3. Urinary System (…Cont’d) Further divided by procedure Incision Excision

  4. Kidney (50010- 50593) Endoscopy codes for procedures done through Previously establishedstoma Incision Most cystoscopy procedures have zero global days A cystoscopy is a visual examination of urinary bladder by means of cystoscope Figure: 19.6

  5. Incision (50010-50135) Caution: Kidney located in retroperitoneal area Each has codes for procedures Renal exploration Kidney diagnostic procedure (50010), no further procedures performed Retroperitoneal area diagnostic procedure (49010) Renal abscess Kidney abscess (50020) If radiological supervision & interpretation were performed see 75989 Retroperitoneal abscess (49060)

  6. Procedures Nephrostomy (50040): Insertion of catheter into kidney with one end in kidney and one end outside body Nephrotomy (50045): Exploration of inside of kidney No definitive procedure Verify all CCI code edits to prevent unbundling Nephrolithotomy (50060-50075): Removal of calculus (Cont’d…)

  7. Procedures (…Cont’d) ESWL:Use of shock waves to fragment calculus Percutaneous lithotripsy: Insertion of probe to pulverize calculus Basket attached to probe and pulverized calculus removed Percutaneous nephrostolithotomy (PCNL) or pyelostolithomy Removal of kidney calculus Figure: 19.3

  8. Excision (50200-50290) Nephrectomy: Partial or total (radical) excision of kidney (50220-50240) Radical: Removal of fascia, fatty tissue, regional lymph node, adrenal gland Nephrectomy medical record documentation should indicate if procedure was partial or total, laparoscopic, or open, and if any structures were removed Code 50225 describes a complicated nephrectomy because of previous surgery on same kidney Ablation Cryosurgery, 50250 Laparoscope, 50542 Percutaneous, 50593

  9. Renal Transplant (50300-50380) Backbench work Retrieval of organ Deceased (50300) Living (50320, open; 50547, laparoscopy) Preparation of organ Deceased (50323) Living (50325) Transplantation Withoutnephrectomy, 50360 With nephrectomy, 50365 Add -50 for bilateral procedure

  10. Introduction (50382-50398) Aspirations Catheters and injections for radiography Insertion of guidewires Tube changes Usually reported with radiology component

  11. Repair (50400-50540) Pyeloplasty Repair of ureteropelvic junction (UPJ) Simple 50400 Complicated 50405 Closure of fistula (abnormal opening) 50520- 50526

  12. Laparoscopy (50541-50549) Ablation of renal Cyst (50541) Lesion (50542) Cryoablation (50250) Percutaneous (50593)

  13. Endoscopy (50551-50580) Renal endoscopy codes divided by Established connection between kidney and body exterior (50551-50562) Nephrotomy or pyelotomy (50570-50580) Further divided based on purpose Biopsy Removal of foreign body/calculus

  14. Ureter Divided based on type of procedure Incision Excision Laparoscopy codes describe surgical procedures Codes may be bilateral or unilateral

  15. Incision (50600-50630) Report open procedures Explore or drain (50600) Insert indwelling stent (50605) Remove calculus (50610-50630) Based on location of upper third, middle third, or lower third

  16. Excision and Introduction (50650-50690) Excision Ureterectomy (50650, 50660) Bladder cuff excision or total excision Introduction Reports injections,manometric (measures pressure) studies, change of stents/tubes

  17. Laparoscopy and Endoscopy (50945-50980) Laparoscopic placement of urethral stent (50947, 50948) Endoscopy codes (50951-50980) for procedure through established stoma

  18. Bladder Many bundled codes Example: Urethral dilation is included with insertion of cystoscope Read all descriptions carefully for site, technique, and reason for procedure Figure: 19.8

  19. Incision and Excision Incision (51020-51080) Suprapubic catheter placement, 51102 Cystotomy (51020-51045) for lesion destruction, insertion of radioactive material, fulguration (use of electrical current) Excision (51500-51597) Cystotomies & cystectomies (51520-51596) Codes divided based on extent of procedure

  20. Introduction (51600-51720) Injection procedures (51600-51610) for urethrocystography Radiographic S&I reported separately Instillation of anticarcinogenic agent via a catheter for bladder cancer Retention time included

  21. Urodynamics (51725-51798) Procedures relate to motion and flow of urine (motor & sensory function) Used to diagnose urine flow obstructions Bundled: All usual, necessary instruments, equipment, supplies, and technical assistance Always code urodynamic code in addition to all other cysto codes if both are performed Modifier -51 is reported for multiple procedures

  22. Repair and Laparoscopy Repair (51800-51980) Cystoplasty Cystourethroplasty Vesicourethropexy/uretropexy (urinary incontinence) Laparoscopy (51990- 51999) Stress incontinence procedures

  23. Endoscopy—Cystoscopy, Urethroscopy, Cystourethroscopy 52000-52010 Many combination codes Notes before 52000 indicate that included are: Meatotomy Urethral calibration Urethral dilation Urethroscopy Cystoscopy Ureteral catheterization, etc.

  24. Endoscopy—Cystoscopy, Urethroscopy, Cystourethroscopy • 52000 is assigned for IVP, if appropriate • 52005 is assigned for retrograde pyelogram • When coding cystourethroscopies with dilation ask following questions: • Is patient male or female? • Is this an initial or subsequent procedure? • Was general or spinal anesthesia used? • Additional time/effort of second procedure • Modifier -22

  25. Transurethral Surgery (52204-52355) Urethra/bladder, 52204-52318 TURBT (52234-52240) Excision or fulguration of bladder tumor Ureter/pelvis, 52320-52355 Includes insertion and removal of temporary stents

  26. Vesical Neck and Prostate (52400-52700) Contains codes for transurethral resection of the prostate(TURP) Example: 52601 complete transurethral electrosurgical resection of the prostate Other approaches are reported with 55801-55845 Example: 55801 reports a removal of the prostate gland (prostatectomy) through an incision in the perineum

  27. Urethra Excision (53200-53275) 53210 female 53215 male Repair (53400-53520) Urethroplasty may be one or two stage Some codes divided based on male/female Manipulation (53600-53665) Stretches of narrowed passage

  28. Male Genital System Anatomic Subsection Penis Testis Epididymis Tunica Vaginalis Scrotum Vas Deferens Spermatic Cord Seminal Vesicles Prostate Figure: 19.10, A & B

  29. Subsection Format • Format: • Incision • Destruction (method used & if simple or extensive) • Excision • Introduction • Repair • Manipulation • Suture

  30. Biopsy Codes Located in subheading to which refer Example Biopsy codes in subheadings: Epididymis (Excision) Testis (Excision)

  31. Penis Incision category differs from Integumentary System codes Penis Incision codes for deeperstructures Example: erectile tissue

  32. Destruction (54050-54065) Codes divided on Extent: Simple or extensive Method of destruction: e.g., chemical, cryosurgery Extensive destruction can be by any method

  33. Excision (54100-54164) Commonly used codes biopsy and circumcision Appropriate circumcision code is based on method and age of patient Biopsy, penis Simple biopsy 54100 (separate procedure) Complex biopsy 54105

  34. Peyronie Disease Curvature of penis Result of plaque formation Surgical removal of plaque (54110- 54112) Grafting may be necessary to correct defect Report with 54111, 54112 If harvesting of graft is through a separate incision, see 20920 & 20926, as appropriate Figure: 19.12

  35. Circumcision Divided based on if device was or was not utilized Clamp: 54150 No clamp: 54160 (neonate), 54161 (non-neonate, less than 28 days)

  36. Introduction (54200-54250) Many procedures for corpora cavernosum (spongy body of penis) Injection procedures for Peyronie disease (toughening of the corpora cavernosum) Treatments for erectile dysfunction 54240 and 54250 have a global, professional (26), and technical component (TC) Use of appropriate modifier is important when assigning If hospital setting, physician uses modifier -26 on procedure code

  37. Repair (54300-54440) Many plastic repairs Some repairs are staged (more than one stage)—Modifier -58 Stage indicated in code description Repair of wounds involving skin and subcutaneous tissue of external male genitalia: See Integumentary Section codes 12001-13300

  38. Chordee and Hypospadias Chordee: Ventral curve (downward) of penis Hypospadias: Congenital abnormality Urethral meatus (opening) is abnormally placed Repair codes report repair services for chordee and hypospadias

  39. Testis Excision (54500-54535) Biopsy, excision, orchiectomy Biopsy: Incisional or percutaneous Orchiectomy codes reported by: Simple or radical Unilateral or bilateral With or without testicular prosthesis insertion Approach used (Cont’d…)

  40. Testis (…Cont’d) Exploration (54550, 54560) Undescended testis (crypotochildism) Congenital Testis or testes did not descend into scrotal sac Unilateral or bilateral Often associated with hernia Repair (54600-54680) Orchiopexy: Moving and fixation of testis to scrotal sac Abdominal approach: 54650 Laparoscopic: 54692 Code selection based on approach (inguinal, scrotal, or abdominal) Check CCI edits for bundled procedures

  41. Epididymis Narrow, coiled tube Connects efferent ducts to vas deferens I&D abscess or hematoma: 54700 Excision category (54800-54861) Biopsy Lesion or spermatocele (cyst) Repair Category (54900, 54901) Vasectomy reversal (epididymovasostomy) Report operating microscope separately (69990)

  42. Tunica Vaginalis (55000-55060) Serous sheath of testis Site ofhydrocele (fluid collection) (unilateral or bilateral) Treatment options, such as aspirate, inject, excise, repair Repair: Bottle type repair (55060) Drain Reposition Catheter left in place

  43. Scrotum (55100-55180) Sac that contains testes Site of lesion, abscess, hematoma I&D Scrotoplasty (oscheoplasty) Traumatic defect Congenital abnormality May require grafting Simple skin flaps included scrotoplasty More complex grafts/flaps reported separately

  44. Vas Deferens (55200-55450) Tube that conducts sperm from testes to urethra Incision: Vasotomy to collect sperm sample or identify obstruction Excision: Vasectomy for sterilization procedure is described as either unilateral or bilateral Do not use modifier -50 Introduction: Dye forradiographic procedure Repair: Remove obstruction, anastomose ends, semen sampling included Operating microscope: 69990

  45. Spermatic Cord (55500-55559) Hydrocele: 55500 with -50 bilateral Variocele: Trapped blood causes vessels to swell, for excision: Scrotalapproach: 55530 Abdominal approach: 55535 Laparoscopy: 55550 Excision of varicocele and hernia repair: 55540 Watch: “separate procedure” designation. Only billed if only service performed or if procedure totally unrelated to another procedure performed during the same session Figure: 19.13

  46. Seminal Vesicles (55600-55680) Pair of bands, posterior to bladder Provide majority of semen fluid Incision: Vesiculotomy Simple 55600,complicated55605 Excision: Vesiculectomy For removal of tumor, calculus, or other obstruction 55650, any approach Add -50 for bilateral

  47. Prostate (55700-55899) BPH, Benign Prostatic Hyperplasia Enlargement of the prostate Treatment options: Urethral stent keeps urethra open at level of prostate 52282, permanent 53855, temporary TUMT (53850) microwave heat TUNA (53852) radiofrequency Each code description lists approach and bundled procedures, if appropriate

  48. Incision (55700-55725) Prostate Biopsy Needle or punch, 55700 Needle, transperineal, stereotactic, 55706 Incisional, 55705 When fine needle biopsy/aspiration performed refer to 10021 & 10022 Prostatotomy (55720 simple, 55725 complicated) Drain abscess Either via perineum or through rectum Complicated = documented complexity, such as excess bleeding

  49. BPH or Neoplasm Surgical Options TURP (52601, 52630) gold-standard Through urethra, electrical loop removes obstruction TUIP (52450) Incisions relieve pressure, no tissue removed

  50. Prostatectomy Two types of codes: Coagulation (52647) Vaporization (52648) Vaporization may be with or without resection (Cont’d…)

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