Summary & Overview
CPT 53240: Incision to Open Urinary Diverticulum
CPT code 53240 represents a surgical incision to create an opening in a urinary diverticulum to improve urination and relieve pain in male and female patients. This code captures a targeted urologic procedure that can affect patient quality of life and resource use in surgical settings. Nationally, accurate coding of such procedures supports appropriate clinical documentation and payer adjudication for urologic surgical care. Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise clinical context for the procedure, a summary of typical sites of service (hospital operating room and ambulatory surgical center), and the common modifiers associated with billing this service. The publication also provides benchmarks and coding guidance relevant to payers listed above, notes on documentation expectations, and references to related procedures where applicable. Policy updates and reimbursement considerations that affect national billing practices for urologic surgery are summarized to inform revenue cycle and clinical coding professionals.
Data not available in the input for specific ICD-10 diagnoses, associated taxonomies, and related codes.
Billing Code Overview
CPT code 53240 describes a surgical procedure in which the provider creates an opening in a diverticulum by making a surgical incision. The procedure is performed to improve urination and relieve pain in both male and female patients.
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Service type: Surgical incision to open a urinary diverticulum (procedural/urologic surgery)
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Typical site of service: Hospital operating room or ambulatory surgical center, depending on patient condition and procedural setting
Data not available in the input for payers, associated taxonomies, and ICD-10 diagnoses.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult (male or female) presenting with lower urinary tract symptoms such as obstructive voiding, urinary retention, recurrent urinary tract infections, or pelvic pain caused by a symptomatic urethral diverticulum. The patient often has prior conservative management (antibiotics, catheterization, or pelvic floor therapy) with persistent symptoms. Diagnostic workup includes history and physical exam, urinalysis and urine culture, pelvic or transvaginal ultrasound, MRI of the pelvis or cystourethroscopy to identify the diverticulum size and location. The surgical workflow for 53240 (diverticulectomy with creation of an opening in a diverticulum by incision to improve urination and relieve pain) typically occurs in an operating room or ambulatory surgical center under general or regional anesthesia. The procedure is performed by a urologist or urogynecologist: cystoscopic evaluation is performed intraoperatively, the diverticulum is incised and drained or unroofed to create a patent opening, hemostasis is achieved, and the urethral and periurethral tissues are repaired as indicated. Intraoperative monitoring and postoperative instructions include antibiotics, urinary catheter management, analgesia, and follow-up imaging or cystoscopy to confirm symptom resolution and wound healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work required is substantially greater than typically required (document intensified complexity). |