Z628

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 726 / T6

UROGENITAL AND URINARY SURGICAL PROCEDURES
PREAMBLE - BLADDER AND URETHRA
 1. No extra claim should be made for EUA when done at the time of cystoscopy.
 2. Visit fees, as applicable, to be claimed for changing a suprapubic tube.
 3. No claim should be made for pre-cystoscopy dilatation of the male urethra unless urethral
    stricture is the primary diagnosis. No claim should be made for dilatation of the female urethra
    when done at the same time as cystoscopy.
 4. “E” prefixed codes are payable in addition to any “S” or “Z” code listed under the “Bladder”
    subheading or to Z626 or Z628, unless separately noted.

Master, record 7351. Record Layout PDF, page 1.

Z62820260401999999990000125700000000000000000000000000000095760000000957600

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.