CPT ® 54535 in section: Orchiectomy, radical, for tumor CPT ® Code Set 54535 - CPT® Code in category: Orchiectomy, radical, for tumor CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more.
In males, when a radical prostatectomy is performed in addition to radical cystectomy during the same operative session, both procedures may be billed. The CPT® code 55840 "prostatectomy; retropubic radical, with or without nerve sparing" can be billed with a -51 modifier in addition to the appropriate cystectomy code.
For example, as noted in MLN Matters® Article MM9633, effective July 1, 2016, the global surgery days for CPT Category III codes 0437T, 0439T, and 0443T were set to ZZZ. Other such codes are identified as YYY. Effective January 1, 2016, CMS issued the following code changes affecting global surgery: 44799: Global Surgery Days = YYY
Z90.79 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
Acquired absence of other genital organ(s) The 2022 edition of ICD-10-CM Z90. 79 became effective on October 1, 2021.
ICD-10-CM Code for Encounter for surgical aftercare following surgery on specified body systems Z48. 81.
ICD-10 code N52. 31 for Erectile dysfunction following radical prostatectomy is a medical classification as listed by WHO under the range - Diseases of the genitourinary system .
Personal history of malignant neoplasm of testis Z85. 47 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z85. 47 became effective on October 1, 2021.
Z09 - Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm | ICD-10-CM.
For example, if a patient with severe degenerative osteoarthritis of the hip, underwent hip replacement and the current encounter/admission is for rehabilitation, report code Z47. 1, Aftercare following joint replacement surgery, as the first-listed or principal diagnosis.
Prostate Cancer (ICD-10: C61)
The CPT® code 55840 "prostatectomy; retropubic radical, with or without nerve sparing" can be billed with a -51 modifier in addition to the appropriate cystectomy code.
CPT® Code 55810 in section: Prostatectomy, perineal radical.
CPT® 54530 in section: Orchiectomy, radical, for tumor.
C62. 91 - Malignant neoplasm of right testis, unspecified whether descended or undescended | ICD-10-CM.
ICD-10 code N50. 819 for Testicular pain, unspecified is a medical classification as listed by WHO under the range - Diseases of the genitourinary system .
Z aftercare codes are used in office follow-up situations in which the initial treatment of a disease is complete and the patient requires continued care during the healing or recovery phase or for long-term consequences of the disease.
ICD-10-CM Code for Complication of surgical and medical care, unspecified, initial encounter T88. 9XXA.
ICD-10-CM Code for Encounter for other orthopedic aftercare Z47. 89.
ICD-10 Code for Disruption of external operation (surgical) wound, not elsewhere classified, initial encounter- T81. 31XA- Codify by AAPC.
The 2022 edition of ICD-10-CM Z90.79 became effective on October 1, 2021.
Z77-Z99 Persons with potential health hazards related to family and personal history and certain conditions influencing health status
If no such code exists, the physician should use the unspecified procedure code in the correct series, which is, 47999 or 64999. The procedure code for the original surgery is not used except when the identical procedure is repeated.
This booklet is designed to provide education on the components of a global surgery package. It includes information about billing and payment rules for surgeries, endoscopies, and global surgical packages that are split between two or more physicians.
The terminology for some procedure codes includes the terms “bilateral” (such as code 27395; Lengthening of the hamstring tendon; multiple, bilateral.) or “unilateral or bilateral” (for example, code 52290; cystourethroscopy; with ureteral meatotomy, unilateral or bilateral). The payment adjustment rules for bilateral surgeries do not apply to procedures identified by CPT as “bilateral” or “unilateral or bilateral” since the fee schedule reflects any additional work required for bilateral surgeries.
Modifier “-25” (Significant, separately identifiable E/M service by the same physician on the same day of the procedure), indicates that the patient’s condition required a significant, separately identifiable E/M service beyond the usual pre-operative and post-operative care associated with the procedure or service.
More than one physician may furnish services included in the global surgical package. It is possible that the physician who performs the surgical procedure does not furnish the follow-up care. Payment for the post-operative, post-discharge care is split among two or more physicians where the physicians agree on the transfer of care.
Critical care services furnished during a global surgical period for a seriously injured or burned patient are not considered related to a surgical procedure and may be paid separately under the following circumstances.
The CPT code (s) use for the open cystoprostatectomy are 51570 Cystectomy complete (separate procedure) and 55840 Prostatectomy, retropubic radical, with or without nerve sparing. There should be supporting documentation for both procedures.
A. You would bill CPT code 52000 when endoscopy procedure is being done through a pouch.
For the laparoscopic prostatectomy there is only one CPT® code 55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed, now for the laparoscopic cystectomy there is no CPT code so we would have to use an unlisted code, 51999 Unlisted laparoscopy procedure, bladder. The unlisted code would need to be equated to a similar CPT code. You may query your physician.
A. Use CPT® code 57311 Closure of urethrovaginal fistula with bulbocavernosus transplant. Append the 52 modifier since bulbocavernosus transplant was not performed.
A. Both surgeons should use the CPT® code 51596, Cystectomy, complete, with continent diversion, any open technique, using any segment of small and/or large intestine to construct neobladder, with modifier -62, Two Surgeons.
A. Under Medicare if a laparoscopic procedure is converted to an open procedure, you may only bill the open procedure . Some commercial carriers will allow billing of the laparoscopic procedure with modifier 52, Reduced Services, or 53, Discontinued Procedure, plus the open procedure code. There is no ICD-10 code at the present time to use.
If additional procedure (s), including add-on procedure (s), are performed by either surgeon during the same surgical session, separate code (s) can be reported without modifier 62. As of (date) Medicare changed their rules for billing modifier 62 Two surgeons must be from different specialties.