Reimbursement

SURE Procedure with CVAC System Has Dedicated Reimbursement

For Reimbursement support, please call 925-526-5900 or email [email protected]

CVAC System Outpatient Facility Coding Guide

Common ICD-10-CM1 Diagnosis Code
ICD-10-CM Diagnosis Code Description
N20.0 Calculus of kidney
Hospital Outpatient
HCPCS2 Description
Procedure Code C9761 Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if applicable (must use a steerable ureteral catheter)
AND
Device Code C1747 Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable)
Ambulatory Surgery Center
HCPCS2 Description
Procedure Code C9761 Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if applicable (must use a steerable ureteral catheter)
AND
Device Code C1747 Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable)
Frequently Used Modifiers
Modifier Description Notes
50 Bilateral Procedure Indicates procedure was performed on both sides of the body. Procedure will usually be paid at 150% of the single procedure code by Medicare.
52 Reduced Procedure Indicates only a portion of the procedure was completed. Procedure will usually be paid at a 50% reduction of the unmodified code by Medicare.

References:

  1. ICD-10-CM 2024. American Medical Association, Chicago, IL 2024
  2. HCPCS Level II, 2024 Expert. Copyright 2024, Optum 360, LLC
  3. Centers for Medicare & Medicaid Services 1786-FC Outpatient Final Rule

CVAC System Physician Coding Guide

Common ICD-10-CM1 Diagnosis Code Reimbursement Support
ICD-10-CM Diagnosis Code Description
N20.0 Calculus of kidney
Professional Fee Coding
CPT2 Description Work RVUs Total RVUs
/ 52353 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included) 7.50 11.43
OR
\ 52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (e.g. Gibbons or double-J type) 8.00 12.11
AND
53899 Unlisted procedure, urinary system
* To report steerable vacuum aspiration of the kidney		 Not established
Frequently Used Modifiers
Modifier Description Notes
22 Increased Procedural Services Indicates additional work was performed over and above the scheduled procedure. Documentation must include the extenuating circumstances encountered intraoperatively that set this procedure apart from the standard expectation of complexity. Payment will usually be 20-30% higher than unmodified code by Medicare.
50 Bilateral Procedure Indicates procedure was performed on both sides of the body. Procedure will usually be paid at 150% of the single procedure code by Medicare.
52 Reduced Procedure Indicates on a portion of the procedure was completed. Procedure will usually be paid at a 50% reduction of unmodified code by Medicare.
58 Staged Procedure Indicates that the performance of a procedure or service during the postoperative period was either:

  1. Planned prospectively at the time of the original procedure (i.e., staged);
  2. More extensive than the original procedure; or
  3. For the therapy following a surgical procedure

Procedure will be paid at 100%.

References:

  1. ICD-10-CM 2024. American Medical Association, Chicago, IL 2024
  2. Current Procedural Terminology 2023, American Medical Association. Chicago, IL 2023. CPT is a registered trademark of the American Medical Association. Current Procedural Terminology (CPT®) is copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Disclaimer: The information contained on this page is for informational purposes only and represents no statement, promise, or guarantee by Calyxo, Inc. concerning levels of reimbursement or payment. It is always the responsibility of the provider to determine if the services provided are accurately described by any specific code(s) and to report services consistent with specific payer requirements. Providers should select the most appropriate HCPCS / CPT® code(s) with the highest level of detail to describe the service(s) rendered to the patient as well as the most appropriate ICD-10-CM diagnosis code(s) to describe the patient’s condition. Any questions should be directed to the pertinent payer regarding reimbursement policies. This information is subject to change at any time. In all cases, services billed must be medically necessary, performed as reported and appropriately documented.