2022 Billing and Coding Guide - Medtronic

2023 Billing and Coding Guide

Urology surgery

This guide is intended to aid providers in appropriate CPT?1 code selection for Urology surgery procedures. The document reflects applicable and commonly billed procedure codes as well as the unadjusted national Medicare average rates assigned to the CPT?1 code. This document is not all-inclusive, nor does it replace advice from your coding and compliance departments and/or CPT?1 coding manuals. CPT?1 code descriptions in this document have been shortened to the consumer-friendly version per the American Medical Association (AMA) guidelines.2 Note, CPT?1 consumer-friendly descriptors should not be used for clinical coding or documentation.3

HCPCS4 II Codes

Level II HCPCS4 codes are primarily used to report supplies, drugs and implants that are not reported by a CPT?1 code. HCPCS codes are reported by the physician, hospital or DME provider that purchased the item, device, or supply. Different payers have different payment methods for these items.

C-codes are a series of HCPCS codes that facilities reimbursed under the Medicare Outpatient Prospective Payment System (OPPS) are required to report for eligible items and services. Medicare assigns C codes to specific devices eligible for pass-through payment. Every year, in the OPPS rule, Medicare publishes a list of CPT?1 and HCPCS codes that are designated as device-intensive procedures. When reporting procedures on this list, facilities should capture both the CPT?1 code representing the procedure performed and the C-code representing the device used. Although C-codes only affect Medicare outpatient reimbursement, facilities may also want to report C-codes on inpatient claims if the device is not used exclusively for inpatient procedures. Medicare tracks this information and uses it in its rate-setting process. Non-OPPS facilities may report C- codes at their discretion.

HCPCS II S-codes cannot be reported to Medicare. They are used only by non-Medicare payers, which cover and price them according to their own policies and provider contracts.

HCPCS4 code

Description

A4649

Surgical supply; miscellaneous

S2900

1

Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)

Procedure reimbursement

CPT?1 code

Description

Cystectomy

Physician5

Work RVU

Office Facility

rate

rate

Hospital outpatient6

APC SI Rate

Ambulatory surgery6

PI Rate

51550 Simple partial removal of bladder

17.23

NA

$962

NA

C

NA NA NA

51555 51565

Complicated partial removal of bladder

Partial removal of bladder with reimplantation of ureters

23.18 23.68

NA

$1,256 NA

C

NA NA NA

NA

$1,284 NA

C

NA NA NA

51570 Complete removal of bladder

27.46

NA

$1,467 NA

C

NA NA NA

51575

Complete removal of bladder and lymph nodes on both sides of pelvis

34.18

NA

$1,810 NA

C

NA NA NA

51580

Complete removal of bladder with transplantation of ureters

35.37

NA

$1,885 NA

C

NA NA NA

Complete removal of bladder with

51585

transplantation of ureters and removal of lymph nodes on both sides of

39.64

NA

$2,096 NA

C

NA NA NA

pelvis

Removal of bladder with

51590

transplantation of ureters to small or large bowel with creation of urinary

36.33

NA

$1,919 NA

C

NA NA NA

opening

Removal of bladder and lymph nodes

on both sides of pelvis with

51595 transplantation of ureters to small or

41.32

NA

$2,171 NA

C

NA NA NA

large bowel with creation of urinary

opening

Removal of bladder and lymph nodes

on both sides of pelvis with

51596 transplantation of ureters to small

44.26

NA

$2,344 NA

C

NA NA NA

and/or large bowel with creation of

urinary opening

Nephrectomy

50220

Removal of kidney and partial removal of ureter

50225

Removal of kidney and partial removal of ureter complicated by previous surgery on same kidney

50230

Removal of kidney, lymph nodes, and/or blood clot from major vein with partial removal of ureter

Please refer to page 4 for footnotes 2

18.68

NA

$1,055 NA

C

NA NA NA

21.88

NA

$1,203 NA

C

NA NA NA

23.81

NA

$1,276 NA

C

NA NA NA

Procedure reimbursement

CPT?1 code

Description

Nephrectomy, continued

50234

Removal of kidney and ureter with partial removal of bladder through same incision

50236

Removal of kidney and ureter with partial removal of bladder through separate incision

50240 Partial removal of kidney

Physician5

Work RVU

Office Facility

rate

rate

Hospital outpatient6

APC SI Rate

Ambulatory surgery6

PI Rate

24.05

NA

$1,300 NA

C

NA NA NA

26.94

NA

$1,459 NA

C

NA NA NA

24.21

NA

$1,322 NA

C

NA NA NA

50543

Partial removal of kidney using an endoscope

50545

Removal of kidney and lymph nodes using an endoscope

50546

Removal of kidney and partial removal of ureter using an endoscope

27.41 25.06 21.87

50548

Removal of kidney and ureter using an endoscope

25.36

Prostatectomy

55801

Partial removal of prostate gland through incision between scrotum and anus

19.80

55810

Removal of prostate gland, glands for sperm movement, and sperm duct

24.29

55812 55815

Removal of prostate gland with lymph node biopsy through incision between scrotum and anus

Removal of prostate gland through incision between scrotum and anus and removal of surrounding lymph nodes on both sides of pelvis

29.89 32.95

55821 Partial removal of prostate (suprapubic) 15.18

NA

$1,484 5362 J1 $9,087 NA

NA

NA

$1,328 NA

C

NA NA NA

NA

$1,201 NA

C

NA NA NA

NA

$1,335 NA

C

NA NA NA

NA

$1,093 NA

C

NA NA NA

NA

$1,301 NA

C

NA NA NA

NA

$1,600 NA

C

NA NA NA

NA

$1,752 NA

C

NA NA NA

NA

$838

NA

C

NA NA NA

55831 Partial removal of prostate (retropubic)

15.60

NA

$860

NA

C

NA NA NA

55840 Removal of prostate Please refer to page 4 for footnotes

3

21.36

NA

$1,165 NA

C

NA NA NA

Procedure reimbursement

CPT?1 code

Description

Prostatectomy, continued

55842 55845 55866

Removal of prostate gland and lymph node biopsy through abdominal incision

Removal of prostate gland and surrounding lymph nodes on both sides of pelvis through abdominal incision

Surgical removal of prostate and surrounding lymph nodes using an endoscope

55867

Simple surgical subtotal removal of prostate using laparoscope

Physician5

Hospital outpatient6

Ambulatory surgery6

Work RVU

Office rate

Facility rate

APC

SI

Rate

PI

Rate

21.36

NA

$1,166 NA

C

NA NA NA

25.18

NA

$1,355 NA

C

NA NA NA

22.46

NA

$1,192 5362 J1 $9,087 NA NA

19.53

NA

$1,047 5362 J1 $9,087 NA NA

Please refer to page 4 for footnotes

Footnotes

NA

Indicates that there is no established Medicare allowable in this site of care

SI

Indicates Status Indicator in the Hospital outpatient setting6

PI

Indicates Payment Indicator in the Ambulatory surgery setting6

+

Add-on codes are always listed in addition to the primary procedure code

Comprehensive APCs (C-APCs)

?

Device intensive

?

Packaged Payment, see Status Indicators in Reimbursement Appendix

||

Modifier, see definitions in Reimbursement Appendix

RVU

Indicates Relative Value Unit

4

Hospital inpatient coding

ICD-10-PCS7 procedure codes are used by hospitals to report surgeries and procedures performed in the inpatient setting. Below are commonly used ICD-10-PCS procedure codes, however codes listed below are not exhaustive as other codes may apply.

ICD-10-PCS7

Description

Cystectomy

0TBB0ZZ

Excision of Bladder, Open Approach

0TBB4ZZ

Excision of Bladder, Percutaneous Endoscopic Approach

0TTB0ZZ

Resection of Bladder, Open Approach

0TTB4ZZ

Resection of Bladder, Percutaneous Endoscopic Approach

Nephrectomy

0TB00ZZ

Excision of Right Kidney, Open Approach

0TB04ZZ

Excision of Right Kidney, Percutaneous Endoscopic Approach

0TB10ZZ

Excision of Left Kidney, Open Approach

0TB14ZZ

Excision of Left Kidney, Percutaneous Endoscopic Approach

0TT00ZZ

Resection of Right Kidney, Open Approach

0TT04ZZ

Resection of Right Kidney, Percutaneous Endoscopic Approach

0TT10ZZ

Resection of Left Kidney, Open Approach

0TT14ZZ

Resection of Left Kidney, Percutaneous Endoscopic Approach

Nephroureterectomy

0TT60ZZ

Resection of Right Ureter, Open Approach

0TT64ZZ

Resection of Right Ureter, Percutaneous Endoscopic Approach

0TT70ZZ

Resection of Left Ureter, Open Approach

0TT74ZZ

5

Resection of Left Ureter, Percutaneous Endoscopic Approach

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