Outpatient Facility Coding Alert

Question: How do you differentiate adult versus pediatric hydroceles

Ohio Subscriber

Answer: There’s a clear distinction between adult and pediatric hydroceles. Pediatric hydroceles are caused by a congenital condition called patent process vaginalis, or a communicating hydrocele. This hydrocele can turn into a hernia if a little piece of intestine comes down between the belly cavity and the scrotum. In adults there is a pocket of fluid caused by trauma or an inflammatory process such as epididymitis.

The surgical treatments differ as well. In an adult, the surgeon treats the hydrocele via an incision in the scrotum. Usually hydroceles are only treated in adults when the pocket of fluid is large. In pediatrics, the surgeon makes the incision in the groin. Repairing a pediatric hydrocele is almost always recommended, because of the communication between the body cavity and the scrotum. It won’t close down spontaneously, and over time the fluid may accumulate in the scrotum and may allow a hernia.

In adults, hydroceles are sometimes treated by draining the fluid pocket and then sometimes injecting an antibiotic. You should code this procedure with 55000 (Puncture aspiration of hydrocele, tunica vaginalis, with or without injection of medication).

Sometimes the urologist, particularly in the case of a pediatric patient, performs the hernia repair and the hydrocelectomy at the same time. Select the hernia code carefully because your choices are age-specific and refer to the type of hernia, some refer to hydroceles. In some complex cases, additional specific codes may need to be reported.

The inguinal hernia codes are 49495-49525. Pediatric codes are 49495 (Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; reducible), 49496 (... incarcerated or strangulated), 49500 (Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible), and 49501 (... incarcerated or strangulated). Other hernia repair codes are for “age 5 years or over” if initial (49505-49507) and “any age” if recurrent or sliding (49520-49525). The inguinal hernia-repair codes can be billed bilaterally.

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