# communicating hycrodelectomy in 5 y/o



## cindyneal (Oct 15, 2013)

Can anyone tell me how you code a unilateral communicating hydrocelectomy in a child?  My doctor did an inguinal approach.  Op report states:


"Next, a right inguinal incision was made.  The subcutaneous tissues and Scarpa fascia were divided with cautery.  The fascia of the external oblique was identified, and the inguinal shelf was developed.  The fascia of the external oblique was opened along the axis of its fibers to expose the right testicular cord.  The cremasteric fibers were divided with cautery.  A vessel loop was placed behind the cord.  The cord was tediously dissected, and the vas was identified.   Immediately adjacent to the vas was a hydrocele sac.  It appeared that the hydrocele from the scrotum is somewhat obliterated in the mid portion of the inguinal canal to a fibrous stalk.  This was tediously dissected off the surface of the vas, certainly sparing the vas.  A portion of the hydrocele sac was excised and sent for pathology.  The hydrocele decompressed clear straw-colored fluid.  The proximal portion was dissected toward the internal ring and ligated with a 4-0 Vicryl tie.  The surgical field was copiously irrigated.  Again, the vas was certainly spared.  The fascia of the external oblique was closed with running 4-0 Monocryl as to recapitulate the external ring.  Scarpa's was approximated with interrupted 4-0 Vicryl.  Prior to that, the ilioinguinal nerve was blocked with 0.25% Marcaine without epinephrine.  The skin edges were also infiltrated.  The skin was closed with running 4-0 Monocryl in a subcuticular fashion.  Steri-Strips and a sterile dressing were applied."

Dr wants to charge 49505 because he states in children with a congenital communicating hydrocele there is an opening in the abdominal wall that allows fluid to collect in the scrotum which is a hernia.  The surgery is the exact same surgery as an inguinal hernia repair.  

I feel this is a 55040, but he is set on the hernia repair code.  What do you all think?

Cindy Neal, CPC


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