# Fowler Stephens Orchiopexy



## KaylaRieken (Mar 28, 2018)

When this happens in stages what are the correct ways to bill.

1st stage says: Laparoscopic Fowler Stephens orchiopexy with ligation of gonadal vessels

Op note says that after assessing the situation looking at the length required to get the testicle from intra-abdominal location to the left hemiscrotum ascertain that freeing up the surrounding abnormal gubernacular attachments and releasing peritoneum some additional length but did not appear as though the short testicular vessels would allow for bringing the left testicle into the left hemiscrotum at all. There would be significatnt shortage of lenth not wanting to risk loss of the left testicle to obtain vascular supply, I elected to perform a first stage fowler stephens orchiopexy. Her Harmonic scalpel, Maryland bipolar scissors were used through 2 additional 5 mm ports were placed in the lateral border of the right rectus muscles separated by 7 cm centered around the periumbilical port one cephalad and one caudal. I was able to tent up the peritoneum running the gonadal vessels and dissect the peritoneum lateral and medial to the gonadal vessels leaving them exposed. Keeping the gonadal vessels well away from the vas deferens these were clipped with 2 clips proximally with a 5 mm clip applier laparoscopically proximally and one clip distally leaving plenty of room for further division of the gonadal vessels at a later date. The testicle appeared to maintain excellent color for 10 minutes after application of clips indicating adequate vascular supply to the vas deferens and its associated vascular supply. 

3-0 Vicryl sutures were used to close the fascia over the peritoneal defects after each trocar was looked out under directed vision and found to be without any significatnt bleeding. 


2nd stage orders: Second stage Laparoscopic left orchiopexy.

Should I have put a 52 modifier on the first stage? So would this be 54692.52 for first stage and 54692 for second stage?


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## pclaybaugh (Mar 29, 2018)

According to what I have read, this can bee coded as a bilateral procedure:
54692-50 - Laparoscopy, surgical; orchiopexy for intra-abdominal testis [GFP 90 days]


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## KaylaRieken (Mar 29, 2018)

This would be done on the same side.


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## pclaybaugh (Apr 3, 2018)

Then I am stumped.


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