UROLOGY PROCEDURE BUNDLES / CPT

UROLOGY PROCEDURE BUNDLES / CPT

LEVEL I – CORE PRIVILEGES CPT

EVALUATION & CLINICAL CARE

Admit, consult, H&P, orders

Fluoroscopy

Circumcision 54161

Cystoscopy 52000

Transrectal Ultrasound w/out Prostate Biopsy 55700

Transrectal Ultrasound with Prostate Biopsy 55700

Wound Debridement, I & D 10060,10061, 10180, 11000-11006, 11040-11044

Laceration Repair 12001-13160

Biopsy Skin Lesion 11100-11101

Excision of Lymph Node 38500, 38570, 38572, 55812, 55842, 38747, 38760, 38765, 55862

KIDNEY/URETER/RETROPERITONEUM 49320
50546
Diagnostic Laparoscopy 50545
Laparoscopy Nephrectomy – Simple 50541
Laparoscopy Nephrectomy – Radical 49000,49002
Laparoscopy Unroofing of Renal Cyst 50220
Exploratory Laparotomy 50240
Nephrectomy - Simple 50220
Nephrectomy - Partial 50234
Nephrectomy - Radical
Nephroureterectomy 50230
Radical Nephrectomy with Regional Lymphadenectomy or 50075
Vena Cava Thrombectomy 50590
Anatrophic Nephrolithotomy 50080
Extracorporeal Shockwave Lithotripsy (ESWL) 50740
Percutaneous Nephrolithotripsy 50130
Pyeloplasty 50610
Pyelolithotomy 52354
Ureterolithotomy 52351
Ureteroscopy - Diagnostic with Biopsy 52353
Ureteroscopy - Diagnostic w/out Biopsy 52352
Ureteroscopic Stone Removal with Laser Lithotripsy 50780
Ureteroscopic Stone Removal w/out Laser Lithotripsy 50782
Ureteroneocystostomy - Single 50783
Ureteroneocystostomy - Duplex 51530
Ureteroneocystostomy - Tailored 50760
Repair Ureterocele - Open 50575
Ureteroureterostomy 52344
Endoscopic Incision UPJ Obstruction 52344
Incision Ureteral Stricture 52300
Balloon Dilation Ureteral Stricture 50715
Endoscopic Incision of Ureterocoele 50860
Ureterolysis
Ureterostomy 50840
Ureteral Plication 38780
Ileal Ureter 49203-49205
Retroperitoneal Lymph Node Dissection - Transabdominal 60540
Retroperitoneal Mass Excision
Adrenalectomy - Open

Revised 06-29-10; revised 11/22/10 (jms)

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BLADDER/PROSTATE 52204
52332
Cystoscopy with Bladder Biopsy
Cystoscopy with Ureteral Stent Placement, Unilatera 52310
Cystoscopy with Ureteral Stent Placement, Bilateral 52005
Cystoscopy with Ureteral Stent Removal 52235
Cystoscopy with Retrograde Pyelogram 52281
Transurethral Resection Bladder Tumor (TURBT) 51050
Dilation or Incision of Bladder Neck Contracture 52317
Open Removal of Bladder Stone 51610
Endoscopic Lithotripsy of Bladder Stone 51600
Retrograde Urethrogram 51010
Voiding Cystourethrography 51550
Suprapubic Tube Placement - Open or Endoscopic 51595
Cystectomy - Partial 51525
Cystectomy - Radical 50785
Bladder Diverticulectomy 51960
Psoas Hitch / Boari Bladder Flap 50845
Enterocystoplasty 44660
Mitrofanoff Procedure 50820
Repair Enterovesical Fistula 51596
Ileal Conduit Urinary Diversion 51596
Neobladder
Continent Cutaneous Diversion 51500
Supravesical Urinary Diversion. 51980
Urachal Excision 52450
Vesicostomy 52601
Transurethral Incision of Prostate (TUIP) 52648
Transurethral Resection Prostate (TURP) 55821
Transurethral Laser Prostatectomy 55842
Open Prostatectomy, Simple – Suprapubic / Retropubic 38770
Radical Prostatectomy
Pelvic Lymph Node Dissection 44346
Pouchoscopy
Parastomal Hernia Repair / Revise 52276
52281
URETHRA/PENIS/SCROTUM/TESTIS/VAGINA/VAS 53415
53215
Transurethral Incision of Urethral Stricture 53240
Dilation of Urethral Stricture 53010
Urethroplasty - End to End, Flap, Graft, Staged 53445
Urethrectomy - Male 53020
Urethral Diverticulectomy 54060
Perineal Urethrostomy 54100
Artificial Urinary Sphincter 54120
Meatotomy 54125
Condyloma Excision 53215
Penile Lesion - Biopsy 54300
Penectomy - Partial 54400
Penectomy - Total 54420
Inguinal Lymph Node Dissection 55250
Repair Penile Curvature / Chordee 54600
Penile Prosthesis 55040
Penile Shunt for Priapism 55530
Vasectomy 54520
Testicle Torsion – Exploration, Repair with Orchiopexy 54530
Hydrocelectomy - Scrotal, Inguinal
Varicocelectomy
Orchiectomy - Scrotal
Orchiectomy - Radical

Revised 06-29-10; revised 11/22/10 (jms)

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URETHRA/PENIS/SCROTUM/TESTIS/VAGINA/VAS (continued)

Excision of Scrotal Lesion 11406, 11420-11424, 11620-11626
Scrotum – Incision and Drainage 55100

Scrotectomy for Fornier’s Disease (Fasciitis) 11004

Spermatocele Resection 54840

Orchiopexy 54640

Biopsy Testis 54505

Testis Prosthesis 54660

Repair Vesicovaginal Fistula 57320

Bladder Neck Suspension / Sling 51845

Cystocele Repair 51990

Rectocele Repair 45560

Enterocele Repair 57556

Vasovasostomy 55400

Hysterectomy, Vaginal 58280, 58275

ADMINISTRATION OF SEDATION AND ANALGESIA

Revised 06-29-10; revised 11/22/10 (jms)

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LEVEL II – ADVANCED PRIVILEGES CPT

BLADDER/PROSTATE/URETHRA/PENIS/VAGINA/CLITORIS 51940
54332
Repair Bladder Exstrophy 54322
Repair Hypospadias Proximal 54385
Repair Hypospadias Distal 15120, 15121
Repair Epispadias
Harvest of Grafts for Genital Reconstruction 52400
Construction of ACE channel 57300, 57305, 57308,
Transurethral Incision of Posterior Urethral Valves 57310
Rectovaginal Fistula Repair 57335
Retrourethral Fistula Repair 56805
Vaginoplasty for Intersex 49500
Cliteroplasty for Intersex
Pediatric Inguinal Hernia 50543
50548
LAPAROSCOPY 50740
55842
Nephrectomy - Partial 38780
Nephroureterectomy 60650
Ureteropyeloplasty 55842
Lymph Node Dissection - Pelvic 54692
Lymph Node Dissection - Retroperitoneal 55530, 55535, 55540, 55550
Adrenalectomy
Prostatectomy - Radical 50543
Orchiopexy 50543
Varicocelectomy 50543
Sacroculpopexy 50548
50544
LAPAROSCOPY WITH ROBOTIC ASSISTANCE
51570, 5575
Nephrectomy – Simple 51550, 51555
Nephrectomy – Radical 55842
Nephrectomy – Partial
Nephreoureterctomy
Pyeloplasty
Ureteroureterostomy
Ureteral Reimplantation
Excision of Bladder Diverticulum
Cystectomy – Total
Cystectomy – Partial
Prostatectomy – Radical
Operation on Seminal Vesical

ROBOTIC (contact Perioperative Services for Robotic Privileging)

Revised 06-29-10; revised 11/22/10 (jms)

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