Chapter 20 Urinary and Male Genital Systems

Lesson 20-1: Urinary System Lesson 20-1 Introduction  Urology primarily uses codes from the Urinary System subsection o The specialty of Nephrology focuses on conditions of the kidney also uses these codes extensively o The Urinary System subsection contains a wide range of codes  Represents many commonly provided services 1. The Urinary System is divided based on anatomic divisions: a. Kidney b. Ureter c. Bladder d. Urethra 2. Further divisions are based on the procedure such as: a. Incision b. Excision c. Etc  Kidney Subheading 1. Endoscopy Category a. For procedures that are performed through: i. A previously established stoma ii. Through an incision 2. Introduction Category a. For catheters and injections for: i. Radiography ii. Aspirations iii. Insertions of guidewires iv. Tube changes b. Usually would be reported in conjunction with the radiology component of a procedure c. Numerous notes that provide further information i. Be certain to read these notes before assigning a code from the category 3. Lithotripsy Category a. Found in the Other Procedure category b. For the use of shock waves i. ESWL – extracorporeal shock wave lithotripsy c. Used to pulverize kidney stones 4. Within the Laparoscopy parenthetic notes (following the code): a. Is information on the correct code if the service was provided using: i. An open procedure OR ii. A laparoscopy procedure 5. Self comprehensive questions: a. Code the following procedure: i. Endoscopy for renal biopsy through established stoma: 1. 50555 – Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation or ureteropyelography, exclusive of radiologic service; with biopsy  Ureter Subheading 1. The codes in the Ureter Subheading are divided based on the procedure:

a. Incision b. Excision 2. The codes in the Laparoscopy category are for surgical procedures a. Are divided based on the therapeutic procedures provided 3. Endoscopy codes: a. Report services performed either through: i. An established stoma ii. An incision b. Further divisions are based on the therapeutic procedure provided: i. Biopsy ii. Fulguration iii. Removal of foreign body iv. Calculus v. Etc. 4. Self comprehension question: a. Code the following procedure: i. Ureteroneocystostomy of single ureter: 1. 50780 – Ureteroneocystostomy; anastomosis of a ureter to a contralateral ureter 2. (For bilateral procedure, report 50780 with modifier -50) 3. (When combined with cystourethroplasty or vesical neck revision, use 51820)  Bladder Subheading 1. There are many bundled codes in the Bladder Subheading a. Must read all the descriptions very carefully to ensure you have the correct code b. Often there is only a slight difference among code descriptions 2. Urodynamics Category a. For procedures that relate to the motion and flow of urine b. Procedures that are used to diagnose conditions in which the urine flow is obstructed c. Bundled into the codes are all: i. Usual ii. Necessary instruments iii. Equipment iv. Supplies v. Technical assistance d. YOU MUST NOT UNBUNDLE THE SERVICES i. AND REPORT ANY OF THESE SERVICES SEPARATELY e. Include both professional / technical components of the service f. If only the physician (professional) component of the service is provided: i. Use modifier -26 ii. This identifies the professional component only  Urethra Subheading 1. Codes are for the usual procedures of: a. Repair b. Excision c. Incision 2. Manipulation Category: a. Dilation

Lesson 20-2: Male Genital System Lesson Introduction  Male Genital System codes will state: o Unilateral o Bilateral  This will indicate if the procedure was performed on only one or both sides  If the code does not state unilateral / bilateral:  Then assume unilateral services is intended  Although it is not stated Format of the Male Genital System 1. The Male Genital System Subsection: a. In the surgery section b. Divided based on the anatomic structure of the system c. Subheadings: i. Penis ii. Testis iii. Epididymis iv. Tunica Vaginalis v. Scrotum vi. Vas Deferens vii. Spermatic Cord viii. Seminal Vesicles ix. Prostate 2. Code descriptions in the Male Genital System subsection state whether the service is: a. Unilateral b. Bilateral c. If no statement is made in the code description: i. The code is for a unilateral service 3. Biopsy codes are located within the subheading to which they refer a. Ex: there are biopsy codes in the: i. Epididymis subheading 1. Excision category ii. Testis subheading 1. Excision category  Penis Subheading 1. Incision Category: a. Codes are for deeper structures than the Incision codes in the Integumentary System Subsection (10060-10160) 2. Destruction Category a. Codes are divided based on the following: i. Extent: 1. Simple a. Codes are subdivided based on the method used for destruction 2. Extensive a. The destruction can be any acceptable method ii. Method 1. Chemical 2. Cryosurgery

3. Excision Category a. Codes are commonly used codes that include: i. Biopsy 1. Codes are divided based on the depth of the mass a. Simple biopsy: i. Accomplished with: 1. Punch 2. Scalpel 3. Scissors ii. Biopsy site is repaired with a simple closure b. Extensive biopsy: i. The mass is in the deeper structures ii. Site of the biopsy is repaired with layered sutures ii. Circumcision 1. Codes are divided based on whether the service was provided to a: a. Newborn: i. An infant from birth to 28 days b. Other than a newborn 4. Introduction Category a. Many of the procedures are for: i. Corporum cavernosa: 1. The spongy body of the penis b. Examples: i. Injection procedures for Peyronie’s disease 1. Toughening of the corporum cavernosa ii. X-ray studies iii. Treatments for erectile dysfunction 5. Repair Category a. Many codes for plastic repairs b. Some repair procedures require more than one stage i. The stage is stated in the code description 6. Self-Comprehension Questions a. Newborn Circumcision using clamp and ring block: i. 54150 – Circumcision, using clamp or other device with regional dorsal penile or ring block ii. (Do not report modifier -63 in conjunction with 54150) iii. (Report 54150 with modifier 52 when performed without dorsal penile or ring block)  Testis Subheading 1. Excision Category: a. Contains: i. Biopsy procedures ii. Lesion excision iii. Orchiectomies 1. If performed with a laparoscope: a. The service code is located in the Laparoscopy category b. NOT the Excision category

 Tunica Vaginalis Subheading: 1. Three categories in this subheading: a. Incision b. Excision c. Repair 2. Often the site of a hydrocele a. Hydrocele: i. A sac of fluid 3. The physician can treat the condition by means of: a. Aspiration b. Excision c. Repair of the site containing the hydrocele 4. A hernia repair often accompanies the hydrocele excision a. Reported separately with codes from the rage of 49495-49501  Scrotum Subheading: 1. Procedures include: a. Incisions b. Excisions c. Repairs 2. The drainage of an abscess is located on the scrotal wall a. Reported with codes from this subheading 3. If the abscess is on the testis: a. Use a code from the Testis subheading 4. If a lesion is excised from the skin of the scrotum: a. Report codes from the Integumentary System 5. Scrotoplasty codes: a. Divided based on whether the procedure was: i. Simple ii. Complicated  Vas Deferens Subheading: 1. Another subheading in the Male Genital System subsection of the Surgery section 2. Procedures on the vas deferens include: a. Vasotomy b. Vasectomy i. A fairly common procedure ii. The vas deferens is cut and the ends sutured and cauterized iii. Procedure includes: 1. Postoperative semen examination iv. If it is performed with a more major procedure: 1. It is not performed separately 2. It is bundled into the more major procedure c. Vasovasorrhaphy  Spermatic Cord Subheading: 1. Excision procedures: a. Those performed for: i. The repair of a hydrocele or lesion ii. The excision of a varicocele 1. Varicocele: a. A dilation of veins of the spermatic cord

 Seminal Vesicles Subheading: 1. Seminal Vesicles: a. Produce the fluid that is mixed with sperm 2. The most common procedures for conditions of the seminal vesicles are: a. Vesiculotomy b. Vesiculectomy  Prostate Subheading: 1. The categories in this subheading are: a. Excision b. Laparoscopy c. Other Procedures d. Incision i. Contains codes for prostate biopsies 1. Performed either by means of: a. Needle b. Punch 2. Codes for incisional biopsies ii. The operational report will indicate the method  Learning Activity 1. Surgical reduction of torsion of right testis with fixation of contralateral testis: a. 54600-RT – Reduction of torsion of testis, surgical, with or without fixation of contralateral testis (right testis) 2. Distal hypospadias repair with chordee using a V-flap advancement completed in one stage: a. 54322 – 1 stage distal hypospadias repair (with or without chordee or circumcision); with simple meatal advancement (eg, Magpi, V-flap)