S459

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

Master, record 5497. Record Layout PDF, page 1.

S45920260401999999990000596950000000774600000000000000000095760000000957600

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.