Procedure Codes and Medical Aid Authorization and Benefits

  1. List of laparoscopic procedure codes
  2. Medical Aid authorization and benefits  

 

List of laparoscopic procedure codes

 

A) Organ Ablative Surgery – Kidney

1. Renal cyst ablation (basic)         
  • Operation for renal cyst: Marsupialisation or excision – 1877
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

2. Simple nephrectomy (basic)
  • Nephrectomy: Primary nephrectomy – 1853
  • Intra-operative ultrasound study – 5115

(Add u/s if excessive fibrosis or adipose tissue and renal hilum difficult to identify).

  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  •  Specialist assistant – 0008
  • If BMI is >35 - 0018

 

3. Radical nephrectomy (basic)
  • Radical with regional lymph adenectomy for tumour – 1857
  • Intra-operative ultrasound study – 5115

(Add u/s if there is a risk of tumor extension through Gerota’s or into renal vein or into the adrenal gland).

  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807  
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

4. Partial nephrectomy (advanced)
  • Nephrectomy: Partial – 1859
  • Intra-operative ultrasound study – 5115 (To evaluate the extent of renal tumor into the normal renal parenchyma, mandatory when available to assure negative tumor margin)
  • Suture major blood vessel (artery or vein) - trauma (major blood vessels are defined as aorta, innominate artery, carotid artery and vertebral artery, subclavian artery, axillary artery, iliac artery, common femoral and popliteal arteries are included because of popliteal artery. The vertebral and popliteal arteries are included because of the relevant inaccessibility of the arteries and difficult surgical exposure – 1396
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

5. Adrenalectomy (advanced)
  • Adrenalectomy: Unilateral – 2995
  • Intra-operative ultrasound study – 5115

(Add u/s to evaluate the plain between kidney and the adrenal gland as well as identifying the tumor extention is very obese patients).

  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807  
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

 

6. Nephro-ureterectomy (advanced)
  • Nephro-ureterectomy – 1863
  • Partial cystectomy – 2007 (Indicated for distal ureter tumors or in tumors where the risk of distal recurrence is high – the bladder is seperately dissected, partially resected and sutured.)
  • Pelvic lymphadenectomy – 2254 (Pelvic lymphnode dissection required as transitional cancer spread is primary through the lymphatic route – separate samples must be taken)
  • Intra-operative ultrasound study – 5115

(Add u/s to idenify the most distal part of the tumor in the ureter and the VU junction).

  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807  
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

B) Reconstructive Laparoscopic Surgery - Kidney

1. Nephropexy (basic)
  • Pyeloplasty – 1881 Rule C
  • Ureterolysis – 1901 (When clinically indicated)
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807  
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

2. Ureterolithotomy (basic)
  • Ureterolithotomy - 1905
  • Ureterolysis – 1901 (When clinically indicated, especially in periureteric fibrosis that complicates ureter dissection)
  • Intra-operative ultrasound study – 5115

(Add u/s to idenify the stone position in the ureter.)

  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

3. Pyelolithotomy (advanced)
  • Pyelolithotomy – 1885
  • Intra-operative ultrasound study – 5115

(Add u/s to idenify the stone position in either the pelvis or calyces, especially the secondary fragments.)

  • J J Stent catheter – 1952
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

4. Nephrolithotomy for staghorn calculus (advanced)
  • Staghorn stone: Surgical –  1871
  • Pyeloplasty – 1881 (When clinically indicated)
  • J J Stent catheter - 1952
  • Intra-operative ultrasound study – 5115

(Add u/s to idenify the stone position in the pelvis or calyces, especially to identify secondary or residual stone fragments.)

  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

5. Repair of ureteral stricture (advanced)
  • Ureterectomy only – 1903
  • JJ stent catheter - 1952
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807  
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

6. Pyeloplasty (advanced)
  • Pyeloplasty – 1881
  • J J Stent catheter - 1952
  • Abberant renal vessel repositioning - 1893
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35  - 0018

 

C) Organ Ablative Surgery – Pelvis

1. Retro PLND and Pelvic LND (basic)
  • Pelvic lymph adenectomy – 2254 / Retroperitoneal lymph adenectomy including pelvic, aortic and renal nodes – 1455
  • Intra-operative ultrasound study – 5115

(Add u/s to idenify the position of lymphnodes on the major bloodvessels.)

  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807  
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

2. Partial cystectomy (basic)
  • Partial cystectomy – 2007
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

3. Bladder diverticulectomy (advanced)
  • Diverticulectomy – 2013
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

4. Radical cystectomy (advanced)
  • Total cystectomy: With conduit construction and ureteric anastomosis – 2003 / Radical total cystectomy with block dissection, ileal conduit and transplantation of ureters – 2009
  • Single J Stent catheter – 1952
  • Retroperitoneal lymph adenectomy including pelvic, aortic and renal nodes – 1455
  • Intra-operative ultrasound study – 5115

(Add u/s to idenify the position of lymphnodes on the major bloodvessels.)

  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

5. Radical prostatectomy (advanced)

  • Retropubic: Radical -2250
  • Retroperitoneal lymph adenectomy including pelvic, aortic and renal nodes – 1455
  • Intra-operative ultrasound study – 5115

(Add u/s to identify the position of lymph nodes on the major blood vessels.)

  • Bladder neck plasty: Male – 2053 (When indicated)
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

D) Reconstructive Laparoscopic Surgery – Pelvis

1. Orchidopexy (basic)
  • Operation for maldescended testicle: Including herniotomy – 2185 or 2196
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807  
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

2. Varicocelectomy (basic)
  • Abdominal ligation of spermatic vein for varicocele – 2199
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807  
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

3. Inguinal hernia repair (basic)
  • Inguinal or femoral hernia adult – 1819 / Inguinal or femoral hernia child under 14 – 1821 / Inguinal hernia infant under 1 – 1823 / Recurrent inguinal or femoral hernia – 1825 / Strangulated hernia or femoral hernia – 1827
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

4. Bladder stone removal (basic)
  • Cysto-lithotomy – 2043
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807  
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

5. VUR repair (advanced)
  • Uretero-neocystostomy – 1932
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

6. Sacrocolpopexy (advanced)
  • Vaginal prolapse: Abdominal approach: Sacrocolpopexy with use of mesh – 2333
  • Moschowitz operation - 2543
  • Cystoplasty, cysto-urethraplasty, vesicolysis - 2037
  • ADD to open procedures where procedure was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

7. VVF repair (advanced)
  • Repair of vesico vaginal fistula: Abdominal approach – 2020 
  • Uretero-neocystostomy – 1932 (When indicated especially in cases where ureteric orifices is stenosed)
  • Cystoplasty, cysto-urethraplasty, vesicolysis – 2037
  • J J Stent catheter  x 2 - 1952
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

8. Ureteroneocystostomy/Boari flap (advanced)
  • Uretero-neocystostomy with Boariplasty – 1931 or 1932
  • J J Stent catheter – 1952
  • ADD to open procedures where procedures was performed through a laparoscope or transanal endoscopic operations (TEO) (for anaesthetic refer to modifier 0027) – 1807
  • Specialist assistant – 0008
  • If BMI is >35 - 0018

 

9. Diagnostic laparoscopy procedure
  • Diagnostic laparoscoy – 2493 (If no treatment is to be done)
  • Specialist assistant – 0008
  • If BMI is >35  - 0018

 

Medical Aid authorization and benefits

Authorization for laparoscopic procedures is not always without difficulty. In the event that a urologist is refused authorization by the medical aid, he/she can still get authorization by submitting a motivation letter in which he/she gives the details of their experience. Here a logbook is of particular value to provide proof of clinical experience. Download the complete logbook templates here.

Further more, the benefits of laparoscopic surgery can be elaborated on in each particular clinical setting. When performed by an experienced laparoscopic surgeon, laparoscopic surgery can have the same financial implications as an open procedure and can in some cases be even more cost effective than in open surgery. This is because although the laparoscopic instruments are more expensive, the overall benefits of a laparoscopic procedure in experienced hands far out way the cost implications of an open procedure and are listed below:   

  1. Faster operating time
  2. Patient almost never requires a blood transfusion
  3. Patient does not need ICU post-op
  4. Patients are usually discharged within 24-48hr after operation
  5. Patients return back to work 3-4 weeks earlier than with open surgery. 

 

To view your medical aid benefits please visit Precision Medical Solutions.

 

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