E753

PDF page 723 / T3

UROGENITAL AND URINARY SURGICAL PROCEDURES
 KIDNEY AND UPPER URINARY TRACT
                                                                                                     Asst    Surg     Anae
    PERCUTANEOUS PROCEDURES
# Z629 Percutaneous nephrostomy....................................................                          164.40    6
# Z623 Insertion of stent .....................................................................              101.95
# Z624 Dilatation of tract.....................................................................              105.25
# Z625 Selective catheterization of calyces (one or more) .................                                   55.35
# Z626 Nephroscopy, percutaneous or retrograde .............................                                 102.85    6
# Z627 Removal of renal calculi..........................................................             6      180.35    7
# E759    - if disintegrated by any method, to Z627..................... add                                 102.85
# E772    - percutaneous removal of staghorn calculus filling renal
            pelvis and extending into calyces .............................. add                             188.15
# Z636 Endoscopic ureterotomy or pyelotomy ...................................   293.00                                7
      [Commentary:
      Z636 is eligible for payment when rendered by percutaneous or retrograde route.]
# Z637 Percutaneous ablation of calyceal diverticulum to include
         dilation of communication with calyx and fulguration .........                                      262.75    6
# Z600 Change of nephrostomy tube .................................................                           44.00
       RENAL TRANSPLANTATION PROCEDURES
      Note:
      Submit on recipient’s claim. These fees do not include immunosuppressive therapy which is on
      a fee-for-service basis.
# E762     - reconstruction or repair of renal artery done in addition
             torenal transplantation procedures ............................ add 307.20
# S435 Kidney transplant ....................................................................         9     1585.10    13
# E769   - team fee (not to be billed when assistant fees are billed)
           ................................................................................... add           260.05
# S434 Kidney re-transplant................................................................           9     1896.35    13
# E771   - team fee (not to be billed when assistant fees are billed)
           ................................................................................... add           350.45
# S436 Donor nephrectomy - unilateral or bilateral (to include renal
           perfusion with hypothermia when rendered by surgeon) ...                            7 700.30                8
# E753    - live donor ................................................................... add   430.35
# E792    - when performed laparoscopically, to S436 ........ add 25%
      Note:
      For nephrological components - see Diagnostic and Therapeutic Procedures.
# Z631 Fine needle aspiration of renal transplant...............................                  45.15
    ENDOSCOPIC PROCEDURES
# S470 Cystoscopy with manipulation and/or removal of calculus and
         retrograde pyelogram if required ........................................                           240.65    6
# Z638 Endoscopic treatment of vesicoureteral reflux by subureteral
         injection of agent, unilateral or bilateral..............................                    6      450.00    6
         Note:
         Z606, Z607, Z611, Z617 and Z628 are not eligible for payment with Z638.

Master, record 1448. Record Layout PDF, page 1.

E75320260401999999990000430350000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.