# orchiectomy & orchiopexy



## ksrkelly7

Need some help with this report.  Codes 54520-RT 54640-LT

This is the problem.  Doc states 54640 was not performed inguinal approach and should not be billed this way.  He would like to bill 54620 on LT.  Any help with this would be appreciated.


Indication for Surgery 
 right testicular torsion, questionable timeline of starting last night vs late this morning
Preoperative Diagnosis 
right testicular torsion
Postoperative Diagnosis 
right testicular torsion, necrotic right testis 
Operation 
right orchiectomy, left orchiopexy 

Findings 
#1 necrotic right testicle, two full twists in spermatic cord, no improvement 30 minutes after detorsion
#2 classic bell-clapper deformity bilaterally
#3 left testis viable, pexed with 2-0 Prolene suture 
Specimen(s) 
 right testis
Complications 
none 
Technique 
After informed consent was obtained, the patient was taken to the operating room, where time-out was performed, and the site of surgery were confirmed. The patient was sedated and intubated by Anesthesia, placed in the supine position.  The genitals prepped and draped in usual surgical fashion and given Ancef antibiotic prophylaxis.  A right hemi-scrotal incision was made with a scalpel, and then deepened through the dartos tissue with Bovie electrocautery.  Once the tunica vaginalis was opened, the testicle was identified and found to be dark blue/purple consistent with a necrotic testicle.  This was delivered through the incision, and there was 720 degree twist of the spermatic cord.  The testicle was de-torsed.  It had a classic bell-clapper deformity. There was no change in the color of the testicle upon detorsion.  The testicle was wrapped in a warm towel, and kept warm throughout the remainder of the surgery.  The testicle did not improve by the end of the case. An incision was made in the tunica albuginea and there was no active bleeding. 
Attention was then turned to the contralateral hemiscrotum.  A transverse incision was made with a scalpel, and then deepened through the dartos tissue with Bovie electrocautery.  The testicle was identified and delivered through the incision.  This had a normal, viable color in appearance and also had a classic bell clapper deformity.  A dartos pouch was created in the dependent portion of the scrotum.  The testicle was pexed into the dartos pouch with interrupted 2-0 Prolene sutures. The tunica vaginalis was closed with a running 3-0 Vicryl suture.  The skin was then closed with a running 3-0 chromic suture with intermittent locking stitches.  Antibiotic ointment was applied to the incision. Attention was then returned to the previously torsed testicle, which had been kept warm and de-torsed throughout the entire operation.  The testicle was still dark purple in appearance and not viable.  The spermatic cord was bluntly divided into 2 pedicles, which were both clamped.  This was then divided distal to the clamps, and the testicle was sent to pathology.  Each pedicle was tied off using a stick tie of 0-0 Vicryl and a free tie 0-0 Vicryl.  Hemostasis was excellent.  The dartos was then closed with a running 3-0 vicryl suture and the skin was closed with a running 3-0 chromic.  Antibiotic ointment was applied to the incision.  A total of 10 mL of 0.25% Marcaine with epinephrine were infiltrated in the skin along both hemi-scrotal incisions.  Fluffs and scrotal support were then applied.  The patient was then awakened, extubated, and transferred to the Postanesthesia Care Unit in stable condition.
Surgical Sweep Complete (Yes/No/Not Applicable) 
all counts correct 
Disposition 
home


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## emcee101

Your doctor is correct. The documentation does not support coding for 54640 - inguinal orchiopexy. Correct coding should be 54520-RT, 54620-LT. (ICD-9 codes 608.89 for testicular atrophy/necrosis and 608.20 testicular torsion.) 

An inguinal orchiopexy is used for treatment of an undecended testicle with the testicle located in the groin area. The physician must move the testicle down from the groin and to the scrotum and them fix it in place to prevent it from retracting back into the groin. This can also be done abdominally if the testicle is located higher up in the abdomen, in which case the CPT 54650 would be used.


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## ksrkelly7

Thank you so much!  Really appreciate it!!

Kelly


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