Urology Coding Alert

The surgical approach detemines the code you should report

As explained in the accompanying article “Look Beyond 54640’s Descriptor for Accurate Orchiopexy, Hernia Coding,” when your urologist performs inguinal orchiopexies and hernia repairs in the same surgical session, you can report both procedures. Work you way through the following questions to determine which codes you should report based on your physician’s work.

1. Did preoperative examination reveal an undescended testicle?

• If no:

--Use code CPT 54550 (Exploration for undescended testis [inginual or scrotal area]) for exploration of inguinal or scrotal area.

--Use code CPT 54560 (Exploration for undescended testis with abdominal exploration) for abdominal exploration.

• If yes, move on to question 2.

2. Did the urologist perform an open or a laparoscopic orchiopexy?

• If open, go on to ask: Was the orchiopexy performed via an inguinal, abdominal, or scrotal approach?

--If inguinal, use code 54640 (Orchiopexy, inguinal approach, with or without hernia repair), commonly performed for ectopic testis.

--If abdominal, use code 54650 (Orchiopexy, abdominal approach, for intra-abdominal testis [e.g., Fowler-Stephens]), commonly performed for undescended testis.

--If scrotal, use code 54600-52* (Reduction of torsion of testis, surgical, with or without fixation of contralateral testis; reduced services), commonly performed for retractile testis. (*There is no code that specifically represents a transscrotal orchiopexy without a testicular detorsion. Instead of using the unlisted-procedure code, report 54600 with modifier 52, Reduced services, to indicate no detorsion was performed.)

• Then, for all three approaches, ask: Did the urologist perform an open hernia repair at the same surgical session as the open orchiopexy?

• If yes: Report the code for the orchiopexy and an appropriate open hernia repair code from codes 49495-49525. Remember to place modifier 51 (Multiple procedures) on the orchiopexy code.

• If no: Report only the code for the open orchiopexy.

• If laparoscopic, go on to ask: Did the urologist perform a laparoscopic hernia repair at the same surgical session as the laparoscopic orchiopexy?

--If yes, go on to ask: Was the hernia initial, or recurrent?

• If initial, report codes 54692 (Laparoscopy, surgical; orchiopexy for intra-abdominal testis) and 49650-51 (Laparoscopy, surgical; repair initial inguinal hernia; multiple procedures).

• If recurrent, report codes 54692 and 49651-51 (Laparoscopy, surgical; repair recurrent inguinal hernia; multiple procedures).

--If no, report just code 54692.