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Pediatric Urological Surgical Procedures

Q.   What is the proper code to bill for a subureteric transureteral injection (STING) procedure for reflux?

A.   Use CPT® code 52327 cystourethroscopy (including ureteral catheterization); with subureteric injection of implant material with one of the following HCPCS code:

L8603 Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies

Bill on paper, acquisition cost invoice required
L8604 Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1ml, includes shipping and necessary supplies (verified 4-7-16)

Carrier discretion
L8606 Injectable bulking agent, synthetic implant, urinary tract, 1ml syringe, includes shipping and necessary supplies (verified 4-7-16)

Bill on paper, acquisition cost invoice required

Q.   What is the proper way to code for an Ileovesicostomy?

A.   Use the CPT® code 50845 Cutaneous appendico-vesicostomy and CPT® code 44120 Enterectomy, resection of small intestine, single resection and anastomosis. Append modifiers 22 and 52 to CPT® code 50845. The reason for the 22 modifier is because the physician uses the small intestine to make the channel and the 52 modifier is added since the appendix is not used.

Q.   What is the correct way to code hypospadias?

A.   Recommended Coding Guidelines for Hypospadias Repair:

The recommendations are guidelines with a degree of latitude given the variability of associated anomalies found in conjunction with hypospadias (penile chordee or angulation, penile torsion, peno-scrotal fusion, bifid scrotum, peno-scrotal transposition). After careful review and discussion, a guideline for coding five typical clinical scenarios was developed for initial surgical repairs. These guidelines are for initial hypospadias repairs only and are not to be used for repair of hypospadias complications or revision surgery. Detailed documentation in the operative report must support the use of each primary and secondary code (additional codes may be used as the guideline is not intended to include all codes given the variety of techniques utilized for hypospadias surgery). Additionally if possible, the medical rationale for the use of a secondary code to improve the outcome of the surgery is encouraged. Correction of penile chordee or penile curvature for all single-stage repairs has always been included with all primary codes since their inception regardless of the technique used to effect penile straightening (additional codes such as 54300, 54304, or 54360 should not be added or unbundled for a dorsal plication stitch or a Nesbitt wedge as an example).

An article from the AUA Policy & Advocacy Brief [pdf] gives hypospadias coding details.