CPT® Code 52402

Official Description

Cystourethroscopy with transurethral resection or incision of ejaculatory ducts

Common Language Description

The procedure described by CPT® Code 52402 involves a cystourethroscopy combined with either a transurethral resection or incision of the ejaculatory ducts. This surgical intervention is primarily aimed at addressing obstructions that may arise due to various factors such as scar tissue, prostatic cysts, or the presence of stones. The ejaculatory ducts are critical structures that transport sperm from the testes to the urethra, and any obstruction in these ducts can lead to significant reproductive issues. The term "TURED" refers to the transurethral resection of the ejaculatory ducts, while "TUIED" denotes the transurethral incision of the ejaculatory ducts. Additionally, the procedure may involve resection of the verumontanum, which is a small anatomical feature located at the distal end of the prostatic urethra where the ejaculatory ducts enter. During the procedure, a cystourethroscope is utilized to visualize the urethra and bladder, allowing the physician to carefully examine the prostatic urethra and the openings of the ejaculatory ducts. The use of a resectoscope equipped with a hook electrode or loop electrode facilitates the incision or resection of the ejaculatory ducts, ensuring that any obstruction is effectively addressed. The procedure is completed with the placement of a Foley catheter to aid in bladder drainage postoperatively.

1. Indications

The procedure described by CPT® Code 52402 is indicated for the treatment of obstructions in the ejaculatory ducts. These obstructions may be caused by various conditions, including:

Scar Tissue: Formation of fibrous tissue that can block the normal passage of fluids through the ejaculatory ducts.
Prostatic Cysts: Fluid-filled sacs that can develop in the prostate and may obstruct the ejaculatory ducts.
Stones: Calcified deposits that can form in the reproductive tract and lead to blockages in the ejaculatory ducts.

2. Procedure

The procedure begins with the insertion of a cystourethroscope into the urethra, allowing the physician to visualize the urethra and bladder. This endoscopic examination focuses particularly on the prostatic urethra and the orifices of the ejaculatory ducts located at the verumontanum. Following this initial assessment, a resectoscope is introduced. A hook electrode is then utilized to incise one or both ejaculatory ducts, effectively addressing the obstruction. In some cases, a loop electrode may be employed to perform a resection of the verumontanum, which may necessitate multiple passes of the cutting loop to ensure adequate removal of obstructive tissue. The success of the incision or resection is confirmed endoscopically by observing fluid refluxing from the opened ducts, indicating that the obstruction has been resolved. To manage any bleeding that may occur during the procedure, cauterization of blood vessels is performed, with careful attention to avoid damaging the openings of the ducts. Once the necessary surgical interventions are completed, the surgical instruments, including the cystourethroscope, are removed, and a Foley catheter is placed in the bladder to facilitate drainage for a period of 24 to 48 hours.

3. Post-Procedure

After the completion of the procedure, patients are typically monitored for any immediate complications. The placement of a Foley catheter is essential for ensuring proper bladder drainage and preventing urinary retention. The catheter is usually kept in place for 24 to 48 hours, after which it is removed. Patients may experience some discomfort, hematuria (blood in urine), or urinary urgency following the procedure, which is generally expected. Follow-up appointments are important to assess recovery and ensure that the obstruction has been adequately addressed. Any signs of complications, such as persistent bleeding or infection, should be reported to the healthcare provider promptly.

Short Descr	CYSTOURETHRO CUT EJACUL DUCT
Medium Descr	CSTO W/TRURL RESCJ/INC EJACULATORY DUXS
Long Descr	Cystourethroscopy with transurethral resection or incision of ejaculatory ducts
Status Code	Active Code
Global Days	000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	3 - Special payment adjustment rules for multiple endoscopic procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Endoscopic Base Code	52000 Cystourethroscopy (separate procedure)
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator	Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P1G - Major procedure - Other
MUE	1
CCS Clinical Classification	118 - Other OR therapeutic procedures, male genital

51	Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
78	Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
GC	This service has been performed in part by a resident under the direction of a teaching physician