E792

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.

PDF page 724 / T4

UROGENITAL AND URINARY SURGICAL PROCEDURES
KIDNEY AND UPPER URINARY TRACT
                                                                                                    Asst         Surg          Anae
    Cystoscopy and diagnostic Ureteroscopy
# Z628 - above intramural................................................................                        125.70          6
# E819   - diagnostic ureteroscopy of second ureter, to Z628 .... add                                             54.65
# E822   - ureteroscopy to upper third of ureter or renal pelvis, to
           Z628........................................................................... add                    39.60
# E760   - with removal of calculus............................................. add                             174.55
# E761   - intracorporeal lithotripsy by any method .................... add                                     100.75
# E820   - with biopsy of one or more sites in ureter and/or pelvis
           using ureteroscope .................................................... add                             53.35
# E823   - resection and fulgarization of one or more ureteral or renal
           pelvic tumours, to Z628.............................................. add                             250.50
      INCISION
    Ureterotomy, abdominal or vaginal exploratory or for drainage
      With removal of calculus
# S445 - upper 2/3 ............................................................................        6         376.80          7
# S446 - lower 1/3.............................................................................        6         482.40          7
      Where ureter has been previously opened
# S447 - upper 2/3 ............................................................................        6         437.20          6
# S448 - lower 1/3.............................................................................        6         522.50          7
      EXCISION
    Ureterectomy
# S449 - including ureterovesical junction ........................................                    6         477.50          7
# S450 - other e.g. partial .................................................................          6         355.60          7
    REPAIR
# S452 Ureteroileal conduit.................................................................           6         844.95          9
# S454 - with ureterectomy and ileal replacement ...........................                           6         957.85          9
# S457 Ureteroureterostomy...............................................................              6         592.05          8
# E792     - when performed laparoscopically, to S457 ........ add 25%
    Re-implantation
# S451 Ureterovesical anastomosis or re-implantation unilateral .......                                6         525.55          8
      Note:
      Not to be billed in addition to S482.
# S561 Re-implantation of ureter with extensive tapering with or
           without ureterolysis.............................................................           6         743.45          8
# S562 Re-implantation of bifid ureter.................................................                6         747.90          8
# E792     - when performed laparoscopically, to S451, S561 or S562
             ........................................................................... add 25%
# 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.

PDF page 725 / T5

UROGENITAL AND URINARY SURGICAL PROCEDURES
 KIDNEY AND UPPER URINARY TRACT
                                                                                                    Asst   Surg     Anae
    Ureterointestinal anastomosis
# S455 - unilateral.............................................................................     6     355.60    7
# S462 - bilateral...............................................................................    6     469.10    6
    Ureterostomy
      Cutaneous
# S458 - unilateral.............................................................................     6     530.55    6
# S463 - with lower third ureterotomy ...............................................                6     409.10    6
# S459 Ureterovaginal fistula ..............................................................     6 596.95 6
    Ureterolysis for periureteral fibrosis
# S460 - unilateral............................................................................. 6 480.25 6
# E792      - when performed laparoscopically, to S460 ........ add 25%
      Note:
      When a physician submits a claim for performing any insured surgical procedure on the same
      patient on the same day as the physician submits a claim for rendering S460, the S460 service
      is included (in addition to the common elements) as a specific element of that other insured
      service.
    Ureteroplasty (Hutch)
# S461 - unilateral.............................................................................     6     355.60    6
    Bladder flap (Boari)
# S427 - to include re-implantation of ureter.....................................                   6     705.80    6
# E792    - when performed laparoscopically, to S427 ........ add 25%
       SUTURE
    Traumatic rupture, or transection (partial or complete)
      Immediate
# S465 - upper 2/3 ............................................................................      6     409.10    6
# S466 - lower 1/3.............................................................................      6     468.70    6
      Late repair
# S467 - upper 2/3 ............................................................................      6     467.85    6
# S468 - lower 1/3.............................................................................      6     517.15    7

PDF page 728 / T8

INCISION
 # S478 Cystotomy or cystostomy........................................................                         6         215.80          6
 # Z480 Cystotomy with trochar and cannula and insertion of tube .....                                                     91.45          6
 # E750    - when done in conjunction with another procedure..... add                                                      27.90
 # S481 Cystolithotomy - when sole operative procedure....................                                      6         279.45          7
 # E792   - when performed laparoscopically, to S481 ........ add 25%
 # S476 Cutaneous vesicostomy..........................................................                         6         468.70          6
                                 EXCISION
     Cystectomy - Partial
 # S482 - partial for tumour or diverticulum (single or multiple) .........                                     6         409.10          6
 # S483 - with reimplantation of ureter ...............................................                         6         592.05          7
 # S490 - with reimplantation of ureters .............................................                          6         786.35          7
 # E792   - when performed laparoscopically, to S482, S483 or S490
            ........................................................................... add 25%
                                         Note:
                                         S482 not to be billed in addition to S451.

PDF page 729 / T9

UROGENITAL AND URINARY SURGICAL PROCEDURES
 BLADDER
                                                                                                      Asst    Surg     Anae
    Cystectomy - Complete
# S484 - complete cystectomy, without transplant............................                           6      848.90    10
# S485 - with ureterointestinal transplant..........................................                   8     1053.70    13
# S453 - with ureteroileal conduit......................................................               9     1340.40    15
# S440 - with continent urinary diversion ..........................................                   9     1582.00    15
# E792   - when performed laparoscopically, to S484, S485, S453 or
           S440................................................................... add 25%
# S438 Retroperitoneal lymph node dissection for bladder cancer,
         specimen must include obturator, internal iliac and external
         iliac nodes as a minimum to the level of the iliac bifurcation,
         bilateral...............................................................................      7      675.35    7
# S441 Creation of continent urinary diversion ...................................                     9     1086.45    15
# S471 Excision of urachal cyst or sinus with or without umbilical
          hernia repair .......................................................................        6      317.65    6
# E792   - when performed laparoscopically, to S471 ........ add 25%
    Extrophy - excision of bladder and repair of abdominal wall
# S488 - inclusive of graft .................................................................          6      230.95    6
# S491 Plastic repair of extrophy using bladder and including skin flaps                               6      703.85    6
    REPAIR
# S512 Repair of ruptured bladder......................................................                6      371.40    6
# S513 Cystoplasty, using intestine ....................................................               8      742.80    9
    Plastic repair of bladder neck
# S518 - child ....................................................................................    6      529.60    6
# S519 - adolescent or adult .............................................................             6      468.70    7

PDF page 729 / T9

DESTRUCTION
# S521 Litholapaxy and removal of fragments....................................                               231.35    6
# E792    - when performed laparoscopically, to S521.........add 25%
       SUTURE
    Closure of fistula
# S522 External, suprapubic ...............................................................     6 279.65                7
      Vesicovaginal
# S523 - vaginal approach ................................................................      6 848.90                6
# S524 - transvesical approach (with or without omental flap) .........                         6 583.60                6
# S525 Vesicorectal or vesicosigmoid.................................................           6 479.10                7
# E792    - when performed laparoscopically, to S522, S524 or S525
            ........................................................................... add 25%
      Note:
      Closure of fistula - see also Operations on the Female Genital System, page V4.

PDF page 735 / U3

MALE GENITAL SURGICAL PROCEDURES
 TESTIS
                                                                                                      Asst   Surg     Anae
    INCISION
# Z703 Abscess ..................................................................................             59.10    6
    BIOPSY
# Z704 Single......................................................................................           59.10    7
# Z705 Bilateral...................................................................................           89.35    7
# Z706    - with vasography ...............................................................                  129.50    6
      Note:
      See also Diagnostic Radiology - GU Tract.
    Orchidectomy
# S589 unilateral .................................................................................    6     182.90    7
# S598 unilateral, radical for malignancy ............................................                 6     361.45    7
# E834    - with insertion of testicular prosthesis, to S589 or S598
            (maximum 2) .............................................................. add                    50.00
# S590 Retroperitoneal lymph node dissecton (RPLND) for testicular
         tumour ................................................................................       6     894.35    8
# E792   - when performed laparoscopically, to S590 ........ add 25%
    REPAIR
    Orchidopexy
# S591 - for undescended testis, any type, one or two stages to
         include hernia repair where required..................................                        6     465.20    7
# S593 Exploration for undescended testicle, without orchidopexy ....                                  6     465.20    7
# E792   - when performed laparoscopically, to S591 or S593
           ........................................................................... add 25%
# S600 Reduction of torsion of testis or appendix testis and
          orchidopexy (one or both sides) if required ........................                6 456.95 6
# S595 Ruptured testicle..................................................................... 6 448.70 7
# S596 Insertion of testicular prosthesis .............................................       6 212.20 6
      [Commentary:
      See Appendix D - Sub-Surface Pathology under Congenital Deformities and Post-Traumatic
      Deformities.]

PDF page 740 / U8

INCISION
# Z712 Biopsy, needle ........................................................................                   91.60         6
# E821    - when performed by transperineal method, to Z712 .........                                            20.00
# Z713 Biopsy, needle with drainage abscess....................................                      6           98.70         6
    EXCISION
    Prostatectomy
# S650 - simple, by retropubic or suprapubic approach, with or
           without removal of bladder stones......................................                6  689.75                     6
# S651 - radical, with or without removal of bladder stones .............                         6 1174.70                    10
# E792     - when performed laparoscopically, to S650 or S651
              ........................................................................... add 25%
      Note:
      1. Prostatectomy (S650, S651) does not include investigative cystoscopy but includes
         vasectomy when rendered.
      2. S651 includes S519 - plastic repair of bladder neck when rendered and/or S636 -
         vesiculectomy when rendered.
# S652 Staging pelvic lymphadenectomy for prostatic cancer
           (laparoscopic or open) must include at a minimum bilateral
           obturator nodes .................................................................. 7 431.20 10
# E792     - when performed laparoscopically, to S652 .........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.]

Master, record 1487. Record Layout PDF, page 1.

E79220110901999999990000000010000000000000000000000000000000000000000000000

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.