Urology Revenue Cycle Management Services

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ICD-10 Urology Superbill Example

Appointment Date & Time: Last Seen Date:
Patient: Gender: DOB: MR# Pat Due: INS Due:
Address: Reason:
Home Phone: Cell Phone: E-Mail:
Case Name: Case No: Case Type: Case Date:
Pr Insurance: Member ID: Co-Pay Amount: Deductible:
Rendering Provider: PCP: Referring Provider:
CPT CODEDescriptionCPT CODEDescriptionCPT CODEDescription
99203Consult51741Uroflow89264Sperm identification from testis tissue, fresh or cryopreserved
99213Follow Up Visit51725Simple Cystometrogram89300Semen analysis; presence and/or motility of sperm including Huhner test (post coital)
52000Cystoscopy51726Complex Cystometrogram89310Semen analysis; motility and count (not including Huhner test)
76872Prostate Ultrasound51702Foley Catheter Insertion89320Semen analysis; volume, count, motility and differential
81000Urinalysis52310Cystoscopy w/ Stent Removal89321Semen analysis; sperm presence and motility of sperm, if performed
55700Prostate Biopsy51798Post‐Voiding Residual89322Semen analysis; volume, count, motility, and differential using strict morphologic criteria (eg, Kruger)
C61Malignant neoplasm of prostateR35.0Frequency of micturitionN35.114Postinfective anterior urethral stricture, not elsewhere classified
N40.1Enlarged prostate with lower urinary tract symptoms (LUTS)N39.0Urinary tract infection, site not specifiedN35.119Postinfective urethral stricture, not elsewhere classified, male, unspecified
N13.8Other obstructive and re ux uropathyN30.00Acute cystitis without hematuriaN35.12Postinfective urethral stricture, not elsewhere classified, female
R33.9Retention of urine, unspecifiedN30.01Acute cystitis with hematuriaN35.8Other urethral stricture, unspecified
R33.0Drug induced retention of urineN30.10Interstitial cystitis (chronic) without hematuriaN40.0Enlarged prostate without lower urinary tract symptoms (LUTS)
R33.8Other retention of urineN30.11Interstitial cystitis (chronic) with hematuriaN13.30Unspecified hydronephrosis
N20.0Calculus of kidneyN30.20Other chronic cystitis without hematuriaN13.1Hydronephrosis with ureteral stricture, not elsewhere classified
N20.9Urinary calculus, unspecifiedN30.21Other chronic cystitis with hematuriaN13.2Hydronephrosis with renal and ureteral calculus obstruction
N20.2Calculus of kidney and ureterN30.30Trigonitis without hematuriaN13.39Other hydronephrosis
R97.2Elevated prostate speci c antigen (PSA)N30.31Trigonitis with hematuriaN43.3Hydrocele, unspecified
N39.41Urge incontinenceN30.40Irradiation cystitis without hematuriaN43.0Encysted hydrocele
N43.40Spermatocele of epididymis, unspecifiedN30.41Irradiation cystitis with hematuriaN43.1Infected hydrocele
N43.41Spermatocele of epididymis, singleN30.80Other cystitis without hematuriaN43.2Other hydrocele
N43.42Spermatocele of epididymis, multipleN30.81Other cystitis with hematuriaN18.9Chronic kidney disease, unspecified
N31.9Neuromuscular dysfunction of bladder, unspecifiedN30.90Cystitis, unspecified without hematuriaN18.1Chronic kidney disease, stage 1
N31.0Uninhibited neuropathic bladder, not elsewhere classifiedN30.91Cystitis, unspecified with hematuriaN18.2Chronic kidney disease, stage 2 (mild)
N31.1Re ux neuropathic bladder, not elsewhere classifiedN15.9Renal tubule-interstitial disease, unspecifiedN18.3Chronic kidney disease, stage 3 (moderate)
N31.2Flaccid neuropathic bladder, not elsewhere classifiedN34.1Nonspecific urehtritisN18.4Chronic kidney disease, stage 4 (severe)
N31.8Other neuromuscular dysfunction of bladderN34.2Other urethritisN18.5Chronic kidney disease, stage 5
C67.9Malignant neoplasm of bladder, unspecifiedN39.3Stress incontinence (female) (male)N18.6End stage renal disease
C67.0Malignant neoplasm of trigone of bladderN35.9Urethral stricture, unspecifiedR35.1Nocturia
C67.1Malignant neoplasm of dome of bladderN35.010Post-traumatic urethral stricture, male, meatalR32Unspecified urinary incontinence
C67.2Malignant neoplasm of lateral wall of bladderN35.011Post-traumatic bulbous urethral strictureR39.81Functional urinary incontinence
C67.3Malignant neoplasm of anterior wall of bladderN35.012Post-traumatic membranous urethral strictureF98.0Non-organic origin
C67.4Malignant neoplasm of posterior wall of bladderN35.013Post-traumatic anterior urethral strictureN39.3Stress incontinence (female) (male)
C67.5Malignant neoplasm of bladder neckN35.014Post-traumatic urethral stricture, male, unspecifiedN39.41Urge incontinence
C67.6Malignant neoplasm of ureteric ori ceN35.021Urethral stricture due to childbirthN39.42Incontinence without sensory awareness
C67.7Malignant neoplasm of urachusN35.028Other post-traumatic urethral stricture, femaleN39.43Post-void dribbling
C67.8Malignant neoplasm of overlapping sites of bladderN35.111Postinfective urethral stricture, not elsewhere classified, male, meatalN39.44Noctural enuresis
N20.1Calculus of ureterN35.112Postinfective bulbous urethral stricture, not elsewhere classifiedN39.45Continuous leakage
N20.2Calculus of kidney with calculus of ureterN35.113Postinfective membranous urethral stricture, not elsewhere classifiedN39.46Mixed incontinence
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Payments:     CHECK: 
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