2015 Hospital Outpatient C-Code Guide REPRODUCTIVE HEALTH GYNECOLOGIC SURGERY AND IMAGING Order Number Reference Part Number C-Code(s) Balloon Uterine Stent Order Number Reference Part Number C-Code(s) Ultrathane® Suprapubic Catheter Set G17080 J-BUS-253000 C2628 G30400 J-USCS-085025 C2627 G17562 J-BUS-404000 C2628 G30401 J-USCS-120025 C2627 Bush SL™ and Bush DL™ Ureteral Illuminating Catheter Sets Cook SSG Injection Catheter Set with Wire Guide G16737 J-BICS-058020 C1758 G30368 G16262 J-BICS-078000 C1758 FluoroSet® Radiographic Tubal Assessment Set J-SICS-030055 C1769 Cook® Cystostomy Suprapubic Catheter G51608 G16697 J-CCS-085400 C2627 Madduri Urethrogram Catheter G16700 J-CCS-105400 C2627 G18926 G16741 J-CCS-125400 C2627 G16742 J-CCS-125410 C2627 Mencini Double Balloon Hysterosalpingography Catheter Rutner Suprapubic Balloon Catheter Set G16565 J-RSB-102200 C2627 G16566 J-RSB-122200 C2627 G17319 J-RSB-142200 C2627 G16567 J-RSB-162200 C2627 Cook® Silicone Balloon HSG Catheter G17472 J-CHSG-503001 C2628 G17471 J-CHSG-703001 C2628 G17147 J-CHSG-503000 C2628 G17870 J-CHSG-703000 C2628 G10432 J-RTAS-100 C1769 J-UGC-140037 DBH-100 C1729 C2628 RÖsch-Thurmond Fallopian Tube Catheterization Set G04324 FTC-900 C1769 Roadrunner® PC Wire Guide with Slip-Coat® Hydrophilic Coating G17850 J-RFPC-035060 C1769 Fallopian Tube Catheterization Set G10991 FTC-550 C1769 G10992 FTC-550-NT C1769 uVue™ HSG/SHG Catheter G24813 J-UHSG-062026 C2628 If you have any questions, please contact our reimbursement team at 800.468.1379 or by e-mail at [email protected]. Slip-Coat is a registered trademark of Angiotech Biocoatings Corp. Disclaimer: The information provided herein reflects Cook’s understanding of the procedure(s) and/or device(s) from sources that may include, but are not limited to, the CPT, ICD-9 and MS-DRG coding systems; Medicare payment systems; commercially available coding guides; professional societies; and research conducted by independent coding and reimbursement consultants. This information should not be construed as authoritative. The entity billing Medicare and/or third party payers is solely responsible for the accuracy of the codes assigned to the services and items in the medical record. Cook does not, and should not, have access to medical records, and therefore cannot recommend codes for specific cases. When you are making coding decisions, we encourage you to seek input from the AMA, AHA, relevant medical societies, CMS, your local Medicare Administrative Contractor and other health plans to which you submit claims. Cook does not promote the off-label use of its devices. © COOK 2015 RG_RH_OPCRG_RE_201501