Billing, Coding & Reimbursement
Reference tables for CPT procedure codes, ICD-10 diagnosis codes, and billing modifiers relevant to functional urology, GU reconstruction, and female pelvic medicine. Use the search bar to find codes quickly, or filter by type.
:::note Disclaimer Code descriptions and wRVU values are for educational reference only and reflect CMS data at time of publication. Verify current values with your institution's coding team or AMA CPT database before billing. :::
CPT Procedure Codes
109 results
| CPT | Procedure Name | Type | wRVUs |
|---|---|---|---|
| 53445 | Insertion of artificial urinary sphincter (bladder neck or urethra), all components | AUS | 13.00 |
| 53447 | Removal and replacement of artificial urinary sphincter (bladder neck or urethra), all components | AUS | 14.28 |
| 53446 | Removal of artificial urinary sphincter (bladder neck or urethra), all components | AUS | 11.02 |
| 53448 | Removal and replacement of artificial urinary sphincter (bladder neck or urethra), all components, infected field | AUS | 23.44 |
| 53449 | Repair of artificial urinary sphincter (bladder neck or urethra): cuff, pump, or reservoir | AUS | 10.56 |
| 53444 | Insertion of tandem cuff (second cuff) artificial urinary sphincter | AUS | 14.19 |
| 54400 | Insertion of penile prosthesis; non-inflatable (malleable) | Penile Prosthesis | 8.50 |
| 54405 | Insertion of multi-component, inflatable penile prosthesis (3-piece IPP) | Penile Prosthesis | 14.52 |
| 54406 | Removal of all components of inflatable penile prosthesis without replacement | Penile Prosthesis | 9.15 |
| 54408 | Repair of component(s) of multi-component inflatable penile prosthesis | Penile Prosthesis | 13.91 |
| 54410 | Removal and replacement of all components of multi-component inflatable penile prosthesis (non-infected) | Penile Prosthesis | 15.18 |
| 54411 | Removal and replacement of all components of multi-component inflatable penile prosthesis (infected field) | Penile Prosthesis | 18.35 |
| 54415 | Removal of non-inflatable (malleable) penile prosthesis without replacement | Penile Prosthesis | 8.88 |
| 54416 | Removal and replacement of non-inflatable (malleable) penile prosthesis | Penile Prosthesis | 12.08 |
| 54417 | Removal and replacement of non-inflatable (malleable) penile prosthesis (infected field) | Penile Prosthesis | 16.10 |
| 54200 | Injection procedure for Peyronie's disease (e.g., collagenase) | Peyronie's | 1.11 |
| 54205 | Injection procedure for Peyronie's disease with surgical exposure of plaque | Peyronie's | 8.97 |
| 54110 | Incision of penile plaque (Peyronie's disease) | Peyronie's | 10.92 |
| 54111 | Incision of penile plaque (Peyronie's disease); with grafting 5 cm or less in length | Peyronie's | 14.42 |
| 54112 | Incision of penile plaque (Peyronie's disease); with graft greater than 5 cm in length | Peyronie's | 16.98 |
| 53400 | Urethroplasty; first stage, for fistula, diverticulum, or stricture (e.g., Johanson) | Urethroplasty | 14.30 |
| 53405 | Urethroplasty; second stage (formation of urethra), including urinary diversion | Urethroplasty | 16.40 |
| 53410 | Urethroplasty, 1-stage reconstruction of male anterior urethra | Urethroplasty | 20.10 |
| 53415 | Urethroplasty, transpubic or perineal, 1-stage, for reconstruction or repair of prostatic or membranous urethra | Urethroplasty | 24.20 |
| 53420 | Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage | Urethroplasty | 18.50 |
| 53425 | Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; second stage | Urethroplasty | 19.80 |
| 53430 | Urethroplasty, reconstruction of female urethra | Urethroplasty | 15.60 |
| 57288 | Sling operation for stress incontinence (e.g., fascia or synthetic) | Sling / SUI | 12.00 |
| 51992 | Laparoscopic sling operation for stress incontinence (e.g., fascia or synthetic) | Sling / SUI | 11.20 |
| 51840 | Anterior vesicourethropexy or urethropexy (e.g., Marshall-Marchetti-Krantz), simple | Sling / SUI | 11.50 |
| 51841 | Anterior vesicourethropexy or urethropexy; complicated (e.g., secondary repair) | Sling / SUI | 14.80 |
| 51845 | Abdomino-vaginal vesical neck suspension with or without endoscopic control (e.g., Stamey, Raz, modified Pereyra) | Sling / SUI | 10.90 |
| 51900 | Closure of vesicovaginal fistula, abdominal approach | Fistula Repair | 22.50 |
| 51920 | Closure of vesicourethral fistula | Fistula Repair | 18.40 |
| 51925 | Closure of vesicouterine fistula with hysterectomy | Fistula Repair | 28.10 |
| 57300 | Closure of rectovaginal fistula; vaginal or perineal approach | Fistula Repair | 14.60 |
| 57305 | Closure of rectovaginal fistula with synchronous colostomy | Fistula Repair | 22.30 |
| 57307 | Closure of rectovaginal fistula with abdominal approach and/or revision of colostomy | Fistula Repair | 25.80 |
| 57308 | Closure of rectovaginal fistula; transperineal approach with perineal body reconstruction | Fistula Repair | 18.20 |
| 51725 | Simple cystometrography (e.g., spinal manometer) | Urodynamics | 1.40 |
| 51726 | Complex cystometrography (with or without voiding pressure studies, urethral calibration and/or urethral pressure profile studies) | Urodynamics | 2.30 |
| 51728 | Complex cystometrography with voiding pressure studies (micturition urethral pressure profile) | Urodynamics | 2.80 |
| 51729 | Complex cystometrography with voiding pressure studies and urethral pressure profile | Urodynamics | 3.10 |
| 51784 | Electromyography studies of anal or urethral sphincter, other than needle | Urodynamics | 1.50 |
| 51785 | Needle electromyography studies of anal or urethral sphincter, any technique | Urodynamics | 2.00 |
| 51798 | Measurement of post-voiding residual urine and/or bladder capacity by ultrasound | Urodynamics | 0.55 |
| 58150 | Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s) and/or ovary(s) | Hysterectomy | 14.18 |
| 58152 | Total abdominal hysterectomy with colpo-urethropexy | Hysterectomy | 17.40 |
| 58180 | Supracervical abdominal hysterectomy (subtotal), with or without removal of tube(s) and/or ovary(s) | Hysterectomy | 13.80 |
| 58200 | Total abdominal hysterectomy including partial vaginectomy; with para-aortic and pelvic lymph node sampling | Hysterectomy | 28.60 |
| 58260 | Vaginal hysterectomy, for uterus 250 g or less | Hysterectomy | 13.50 |
| 58262 | Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) | Hysterectomy | 14.60 |
| 58263 | Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s), with repair of enterocele | Hysterectomy | 16.20 |
| 58267 | Vaginal hysterectomy, for uterus 250 g or less; with colporrhaphy (anterior and/or posterior) | Hysterectomy | 16.80 |
| 58270 | Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele | Hysterectomy | 15.40 |
| 58290 | Vaginal hysterectomy, for uterus greater than 250 g | Hysterectomy | 16.00 |
| 58291 | Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) | Hysterectomy | 17.10 |
| 58292 | Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele | Hysterectomy | 18.60 |
| 58293 | Vaginal hysterectomy, for uterus greater than 250 g; with colporrhaphy (anterior and/or posterior) | Hysterectomy | 19.20 |
| 58294 | Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele | Hysterectomy | 17.80 |
| 58541 | Laparoscopic supracervical hysterectomy, for uterus 250 g or less | Hysterectomy | 14.20 |
| 58542 | Laparoscopic supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) | Hysterectomy | 15.30 |
| 58543 | Laparoscopic supracervical hysterectomy, for uterus greater than 250 g | Hysterectomy | 17.10 |
| 58544 | Laparoscopic supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) | Hysterectomy | 18.20 |
| 58550 | Laparoscopic-assisted vaginal hysterectomy (LAVH), for uterus 250 g or less | Hysterectomy | 14.80 |
| 58552 | LAVH, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) | Hysterectomy | 15.90 |
| 58553 | LAVH, for uterus greater than 250 g | Hysterectomy | 17.50 |
| 58554 | LAVH, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) | Hysterectomy | 18.60 |
| 58570 | Laparoscopic total hysterectomy, for uterus 250 g or less | Hysterectomy | 15.40 |
| 58571 | Laparoscopic total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) | Hysterectomy | 16.50 |
| 58572 | Laparoscopic total hysterectomy, for uterus greater than 250 g | Hysterectomy | 18.20 |
| 58573 | Laparoscopic total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) | Hysterectomy | 19.30 |
| 57240 | Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele, including cystoscopy when performed | Prolapse Repair | 9.80 |
| 57250 | Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy | Prolapse Repair | 8.60 |
| 57260 | Combined anteroposterior colporrhaphy | Prolapse Repair | 12.40 |
| 57265 | Combined anteroposterior colporrhaphy with enterocele repair | Prolapse Repair | 14.20 |
| 57268 | Repair of enterocele, vaginal approach (separate procedure) | Prolapse Repair | 8.90 |
| 57270 | Repair of enterocele, abdominal approach (separate procedure) | Prolapse Repair | 10.60 |
| 57280 | Colpopexy, abdominal approach (open sacrocolpopexy) | Prolapse Repair | 17.80 |
| 57282 | Colpopexy, vaginal extraperitoneal approach (sacrospinous, iliococcygeal) | Prolapse Repair | 12.60 |
| 57283 | Colpopexy, vaginal intraperitoneal approach (uterosacral, levator myorrhaphy) | Prolapse Repair | 13.40 |
| 57425 | Laparoscopic colpopexy (sacrocolpopexy) | Prolapse Repair | 19.60 |
| 57284 | Paravaginal defect repair; open abdominal approach | Prolapse Repair | 14.20 |
| 57285 | Paravaginal defect repair; vaginal approach | Prolapse Repair | 11.80 |
| 57423 | Paravaginal defect repair; laparoscopic approach | Prolapse Repair | 16.40 |
| 57267 | Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior compartment, add-on) | Prolapse Repair | 4.20 |
| 56810 | Perineoplasty, repair of perineum, nonobstetrical | Prolapse Repair | 7.40 |
| 57200 | Colporrhaphy, suture of injury of vagina (nonobstetrical) | Prolapse Repair | 6.80 |
| 57210 | Colporrhaphy, suture of injury of vagina (nonobstetrical); with extension to perineum | Prolapse Repair | 8.20 |
| 57220 | Plastic operation on urethral sphincter, vaginal approach (e.g., Kelly urethral plication) | Prolapse Repair | 7.60 |
| 57230 | Plastic repair of urethrocele | Prolapse Repair | 8.10 |
| 64561 | Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) | Sacral Neuromodulation | 8.20 |
| 64581 | Open implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) | Sacral Neuromodulation | 10.40 |
| 64585 | Revision or removal of peripheral neurostimulator electrode array | Sacral Neuromodulation | 5.60 |
| 64590 | Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver | Sacral Neuromodulation | 5.10 |
| 64595 | Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver | Sacral Neuromodulation | 3.80 |
| 95972 | Electronic analysis of implanted neurostimulator pulse generator system (complex programming) | Sacral Neuromodulation | 1.92 |
| 52287 | Cystoscopy with injection(s) for chemodenervation of the bladder (e.g., onabotulinumtoxinA) | OAB / Botox / PTNS | 5.60 |
| 64566 | Posterior tibial neurostimulation, percutaneous needle electrode, single treatment session (PTNS) | OAB / Botox / PTNS | 1.60 |
| 51715 | Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck (urethral bulking) | OAB / Botox / PTNS | 4.80 |
| 52000 | Cystourethroscopy (separate procedure) | Cystoscopy | 2.28 |
| 52001 | Cystourethroscopy with irrigation and evacuation of multiple obstructing clots | Cystoscopy | 3.40 |
| 52005 | Cystourethroscopy with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography | Cystoscopy | 3.80 |
| 52204 | Cystourethroscopy with biopsy(s) | Cystoscopy | 3.60 |
| 52214 | Cystourethroscopy with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands | Cystoscopy | 4.20 |
| 52224 | Cystourethroscopy with fulguration or treatment of minor bladder lesion(s) less than 0.5 cm | Cystoscopy | 4.10 |
| 52240 | Cystourethroscopy with fulguration or treatment of large bladder tumor(s) | Cystoscopy | 6.80 |
| 52310 | Cystourethroscopy with removal of foreign body, calculus, or ureteral stent from urethra or bladder (simple) | Cystoscopy | 3.20 |
| 52315 | Cystourethroscopy with removal of foreign body, calculus, or ureteral stent; complicated | Cystoscopy | 4.60 |
ICD-10 Diagnosis Codes
124 results
| ICD-10 | Description | Notes | Condition |
|---|---|---|---|
| N39.3 | Stress incontinence (male) (female) | — | Stress Incontinence |
| N39.41 | Urge incontinence | — | Stress Incontinence |
| N39.46 | Mixed incontinence | Stress + urge components | Stress Incontinence |
| T83.1 | Mechanical complication of other urinary devices and implants | — | AUS Complications |
| T83.11 | Breakdown (mechanical) of other urinary devices and implants | — | AUS Complications |
| T83.111 | Breakdown (mechanical) of implanted urinary sphincter | — | AUS Complications |
| T83.111A | Breakdown (mechanical) of implanted urinary sphincter, initial encounter | Use for active treatment | AUS Complications |
| T83.12 | Displacement of other urinary devices and implants | — | AUS Complications |
| T83.121 | Displacement of implanted urinary sphincter | — | AUS Complications |
| T83.19 | Other mechanical complication of other urinary devices and implants | — | AUS Complications |
| T83.191 | Other mechanical complication of implanted urinary sphincter | — | AUS Complications |
| T83.191A | Other mechanical complication of implanted urinary sphincter, initial encounter | — | AUS Complications |
| T83.5 | Infection and inflammatory reaction due to prosthetic device, implant and graft in urinary system | — | AUS Complications |
| T83.591 | Infection and inflammatory reaction due to implanted urinary sphincter | — | AUS Complications |
| T83.591A | Infection and inflammatory reaction due to implanted urinary sphincter, initial encounter | — | AUS Complications |
| T83.598 | Infection and inflammatory reaction due to other prosthetic device, implant and graft in urinary system | — | AUS Complications |
| T83.598A | Infection and inflammatory reaction due to other prosthetic device, implant and graft in urinary system, initial encounter | — | AUS Complications |
| N52.01 | Erectile dysfunction due to arterial insufficiency | — | Erectile Dysfunction |
| N52.02 | Corporo-venous occlusive erectile dysfunction | — | Erectile Dysfunction |
| N52.03 | Combined arterial insufficiency and corporo-venous occlusive erectile dysfunction | — | Erectile Dysfunction |
| N52.1 | Erectile dysfunction due to diseases classified elsewhere | — | Erectile Dysfunction |
| N52.2 | Drug-induced erectile dysfunction | — | Erectile Dysfunction |
| N52.3 | Postprocedural erectile dysfunction | Use specific subcodes when possible | Erectile Dysfunction |
| N52.31 | Erectile dysfunction following radical prostatectomy | — | Erectile Dysfunction |
| N52.32 | Erectile dysfunction following radical cystectomy | — | Erectile Dysfunction |
| N52.33 | Erectile dysfunction following urethral surgery | — | Erectile Dysfunction |
| N52.34 | Erectile dysfunction following simple prostatectomy | — | Erectile Dysfunction |
| N52.35 | Erectile dysfunction following radiation therapy | — | Erectile Dysfunction |
| N52.36 | Erectile dysfunction following interstitial seed therapy | — | Erectile Dysfunction |
| N52.37 | Erectile dysfunction following prostate ablative therapy | — | Erectile Dysfunction |
| N52.39 | Other and unspecified postprocedural erectile dysfunction | — | Erectile Dysfunction |
| N52.8 | Other male erectile dysfunction | — | Erectile Dysfunction |
| N52.9 | Male erectile dysfunction, unspecified | — | Erectile Dysfunction |
| N48.6 | Induratio penis plastica (Peyronie's disease) | — | Peyronie's Disease |
| N48.30 | Priapism, unspecified | — | Priapism |
| N48.31 | Priapism due to trauma | — | Priapism |
| N48.32 | Priapism due to disease classified elsewhere | — | Priapism |
| N48.33 | Priapism, drug-induced | — | Priapism |
| N48.39 | Other priapism | Ischemic, not elsewhere classified | Priapism |
| N48.89 | Other specified disorders of penis | — | Priapism |
| N35.010 | Post-traumatic urethral stricture, male, meatal | — | Urethral Stricture |
| N35.011 | Post-traumatic bulbous urethral stricture | — | Urethral Stricture |
| N35.012 | Post-traumatic membranous urethral stricture | — | Urethral Stricture |
| N35.013 | Post-traumatic anterior urethral stricture | — | Urethral Stricture |
| N35.016 | Post-traumatic urethral stricture, male, overlapping sites | Panurethral stricture | Urethral Stricture |
| N35.111 | Postinfective urethral stricture NEC, male, meatal | — | Urethral Stricture |
| N35.112 | Postinfective bulbous urethral stricture NEC | — | Urethral Stricture |
| N35.116 | Postinfective urethral stricture NEC, male, overlapping sites | Panurethral stricture | Urethral Stricture |
| N35.810 | Other urethral stricture, male, meatal | — | Urethral Stricture |
| N35.812 | Other urethral membranous stricture | — | Urethral Stricture |
| N35.814 | Other anterior urethral stricture, male | — | Urethral Stricture |
| N35.816 | Other urethral stricture, male, overlapping sites | Panurethral stricture | Urethral Stricture |
| N35.82 | Other urethral stricture, female | — | Urethral Stricture |
| N35.9 | Urethral stricture, unspecified | — | Urethral Stricture |
| N99.110 | Postprocedural urethral stricture, male, meatal | — | Urethral Stricture |
| N99.111 | Postprocedural bulbous urethral stricture | — | Urethral Stricture |
| N99.112 | Postprocedural membranous urethral stricture | — | Urethral Stricture |
| N99.113 | Postprocedural anterior bulbous urethral stricture | — | Urethral Stricture |
| N99.116 | Postprocedural urethral stricture, male, overlapping sites | — | Urethral Stricture |
| N99.12 | Postprocedural urethral stricture, female | — | Urethral Stricture |
| N82.0 | Vesicovaginal fistula | — | Fistula |
| N82.1 | Other female urinary-genital tract fistulae | Includes ureterovaginal, urethrovaginal | Fistula |
| N82.3 | Fistula of vagina to large intestine (rectovaginal fistula) | — | Fistula |
| N82.4 | Other female intestinal-genital tract fistulae | — | Fistula |
| N36.0 | Urethral fistula | — | Fistula |
| N32.1 | Vesicointestinal fistula | Includes vesicoenteric, vesicosigmoid | Fistula |
| N32.2 | Vesical fistula, not elsewhere classified | — | Fistula |
| N31.0 | Uninhibited neuropathic bladder, not elsewhere classified | — | Neurogenic Bladder |
| N31.1 | Reflex neuropathic bladder, not elsewhere classified | — | Neurogenic Bladder |
| N31.2 | Flaccid neuropathic bladder, not elsewhere classified | — | Neurogenic Bladder |
| N31.8 | Other neuromuscular dysfunction of bladder | — | Neurogenic Bladder |
| N31.9 | Neuromuscular dysfunction of bladder, unspecified | — | Neurogenic Bladder |
| N81.0 | Urethrocele | — | Prolapse |
| N81.10 | Cystocele, unspecified | — | Prolapse |
| N81.11 | Cystocele, midline | — | Prolapse |
| N81.12 | Cystocele, lateral | Paravaginal defect | Prolapse |
| N81.2 | Incomplete uterovaginal prolapse | — | Prolapse |
| N81.3 | Complete uterovaginal prolapse | — | Prolapse |
| N81.4 | Uterovaginal prolapse, unspecified | — | Prolapse |
| N81.5 | Vaginal enterocele | — | Prolapse |
| N81.6 | Rectocele | — | Prolapse |
| N81.81 | Perineocele | — | Prolapse |
| N81.89 | Other female genital prolapse | — | Prolapse |
| N32.81 | Overactive bladder | Primary diagnosis for OAB | OAB / LUTS |
| R39.15 | Urgency of urination | Use with OAB when urgency is predominant symptom | OAB / LUTS |
| R35.0 | Frequency of micturition | — | OAB / LUTS |
| R35.1 | Nocturia | — | OAB / LUTS |
| R35.89 | Other polyuria | — | OAB / LUTS |
| N39.41 | Urge incontinence | — | OAB / LUTS |
| N39.43 | Post-void dribbling | — | OAB / LUTS |
| N39.44 | Nocturnal enuresis | — | OAB / LUTS |
| N39.45 | Continuous leakage | May indicate fistula | OAB / LUTS |
| N39.490 | Overflow incontinence | — | OAB / LUTS |
| N39.498 | Other specified urinary incontinence | — | OAB / LUTS |
| R33.0 | Drug-induced urinary retention | — | Voiding Dysfunction |
| R33.8 | Other retention of urine | — | Voiding Dysfunction |
| R33.9 | Retention of urine, unspecified | — | Voiding Dysfunction |
| R39.12 | Poor urinary stream | — | Voiding Dysfunction |
| R39.14 | Feeling of incomplete bladder emptying | — | Voiding Dysfunction |
| R39.16 | Straining on urination | — | Voiding Dysfunction |
| R39.198 | Other difficulties with micturition | — | Voiding Dysfunction |
| N13.8 | Other obstructive and reflux uropathy | — | Voiding Dysfunction |
| N30.10 | Interstitial cystitis (chronic) without hematuria | — | Interstitial Cystitis |
| N30.11 | Interstitial cystitis (chronic) with hematuria | — | Interstitial Cystitis |
| N30.30 | Trigonitis without hematuria | — | Interstitial Cystitis |
| N30.31 | Trigonitis with hematuria | — | Interstitial Cystitis |
| R30.9 | Painful micturition, unspecified (dysuria) | — | Interstitial Cystitis |
| R30.0 | Dysuria | — | Interstitial Cystitis |
| N32.89 | Other specified disorders of bladder | Use for bladder pain syndrome | Interstitial Cystitis |
| R31.0 | Gross hematuria | — | Hematuria |
| R31.1 | Benign essential microscopic hematuria | — | Hematuria |
| R31.21 | Asymptomatic microscopic hematuria | — | Hematuria |
| R31.29 | Other microscopic hematuria | — | Hematuria |
| N81.84 | Cervical stump prolapse | Post-supracervical hysterectomy | Prolapse |
| N81.85 | Cervicovaginal fistula | — | Prolapse |
| N99.3 | Prolapse of vaginal vault after hysterectomy | Post-hysterectomy vault prolapse | Prolapse |
| N85.2 | Hypertrophy of uterus | May accompany prolapse | Prolapse |
| K62.3 | Rectal prolapse | — | Anorectal |
| K62.89 | Other specified diseases of rectum | — | Anorectal |
| K64.0 | First degree hemorrhoids | — | Anorectal |
| R15.0 | Incomplete defecation | Obstructed defecation syndrome | Anorectal |
| R15.1 | Fecal smearing | — | Anorectal |
| R15.2 | Fecal urgency | — | Anorectal |
| R15.9 | Full incontinence of feces | — | Anorectal |
Billing Modifiers
Modifiers are appended to CPT codes to indicate special circumstances. This is a fixed reference set applicable across all procedure types.
| Modifier | Name | When to Use |
|---|---|---|
| 22 | Increased Procedural Services | Document complexity beyond typical; specify additional time required |
| 50 | Bilateral Procedure | Procedure performed on both sides |
| 51 | Multiple Procedures | Multiple procedures same session (typically applied automatically) |
| 52 | Reduced Services | Procedure partially reduced or a component eliminated |
| 53 | Discontinued Procedure | Procedure stopped after anesthesia due to extenuating circumstances |
| 58 | Staged / Related Procedure | Planned staged procedure or more extensive follow-up in post-op period |
| 59 | Distinct Procedural Service | Different session, site, organ, incision, lesion, or injury — document clearly |
| 62 | Co-Surgeon | Two primary surgeons performing distinct portions; each reports same CPT + 62 |
| 66 | Surgical Team | Highly complex surgery requiring multiple specialties simultaneously |
| 74 | Discontinued Outpatient / ASC Procedure | Procedure aborted after anesthesia started in outpatient or ASC setting |
| 76 | Repeat Procedure — Same Physician | Same CPT, same patient, same day (e.g., STSG at multiple sites) |
| 78 | Unplanned Return to OR | Related procedure during post-op global period |
| 79 | Unrelated Procedure in Post-op Period | Unrelated to primary procedure's post-op global |
| 80 | Assistant Surgeon | Primary surgeon bills CPT alone; assistant bills CPT + 80 |
| 82 | Assistant Surgeon (No Qualified Resident) | Must justify. Primary uses CPT only; assistant uses CPT + 82 |
| XE | Separate Encounter | Service distinct because it occurred during a separate encounter |
| XS | Separate Structure | Service distinct because performed on a separate organ or structure |
| XP | Separate Practitioner | Service distinct because performed by a different practitioner |
| XU | Unusual Non-Overlapping Service | Service does not overlap usual components of the main service |
External Coding Resources
| Resource | Description | Link |
|---|---|---|
| AMA CPT Code Lookup | Official AMA CPT code database (subscription) | ama-assn.org |
| CMS Physician Fee Schedule | CMS fee schedule lookup with current wRVU values | cms.gov |
| AAPC Coder | Comprehensive ICD-10 and CPT lookup tool | aapc.com |
| ICD-10-CM Browser | Official CMS ICD-10 browser | icd10data.com |
| NCCI Edits | CMS National Correct Coding Initiative bundling edits | cms.gov/ncci |
| AUA Coding Guides | AUA coding and reimbursement resources for urologists | auanet.org |
| AUGS Coding Resources | Urogynecology-specific coding guidance | augs.org |