2025 CPT code 53899
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Urinary System Surgery Feed
Use to report urinary system procedures lacking a specific code.
Modifiers may be applicable depending on the specific circumstances of the procedure.Consult the CPT manual for appropriate modifier use.
The medical necessity for a procedure coded with 53899 must be clearly documented. This includes specifying the patient's condition requiring intervention, the benefits of the performed procedure, and why no other existing CPT code appropriately describes the service.
The physician or qualified healthcare provider performing the unlisted urinary system procedure is responsible for all aspects of the procedure, including appropriate patient selection, informed consent, procedural technique, post-operative care, and accurate code selection and documentation.
In simple words: This code is for procedures on the urinary system that don't have their own specific billing code.Your doctor will need to explain why this code is needed instead of a more specific one, and will provide detailed medical records supporting the claim.
CPT code 53899, "Unlisted procedure, urinary system," is used to report procedures on the urinary system not otherwise specified by a unique CPT code.This code requires detailed documentation justifying its use, including a comparison to similar existing codes and the clinical rationale for the procedure.The documentation should clearly explain the procedure performed, its medical necessity, and the rationale for using an unlisted code instead of a more specific code.Submission of operative notes or other pertinent clinical documentation is crucial for successful claim processing.
Example 1: Ureteral stent removal and replacement where no specific CPT code exists for the method used.This could involve unique access or challenging anatomical considerations., Radiofrequency ablation of a renal lesion not otherwise specified by a CPT code, necessitating documentation of the technique and device used., A complex repair of a urethral stricture not precisely described by standard CPT codes, demanding extensive documentation to demonstrate the complexity and justify the unlisted code.
** Due to the nature of this unlisted code, detailed documentation is crucial for accurate coding and reimbursement.Claims utilizing 53899 are frequently subject to audits, requiring meticulous record-keeping.
- Revenue Code: P1G (Major Procedure - Other)
- RVU: RVUs vary significantly based on the specific unlisted procedure performed, geographic location, and payer.Detailed documentation is required for accurate RVU determination and reimbursement.
- Global Days: The global period for code 53899 is dependent upon the specific procedure performed.There is no universal global period assigned to this unlisted code.Documentation of the procedure is crucial for determining the appropriate global surgical period.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier is dependent on the specifics of the unlisted procedure and should be determined based on the clinical context and payer guidelines.
- Fee Schedule: Historical fee schedule data for 53899 will vary by payer and location.It's not readily available in a centralized, standardized format, and varies widely based on the specific procedure performed.
- Specialties:Urology
- Place of Service:Office, Inpatient Hospital, Ambulatory Surgical Center, Hospital Outpatient Department