Urology Coding Alert

Submit 54690 for a laparoscopic orchiectomy.

When your urologist performs an orchiectomy, you will need to confirm multiple details in the medical documentation, including whether your surgeon took a simple or radical approach. You will also need to know if your surgeon performed a partial or a total orchiectomy.

Keep these three handy tips in mind to master orchiectomy coding in your urology practice.

Tip 1: Understand What Orchiectomy Is

When your urologist performs an orchiectomy, he removes one or both testicles. Conditions that lead to an orchiectomy include testicular cancer and testicular damage due to injury or infection or a part of prostate cancer treatment.

Tip 2: Differentiate Between Types of Orchiectomies

Your orchiectomy procedure codes will depend upon the type of procedure your urologist performed. You will need to look for terms such as “radical,” “simple,” and “partial” in the medical documentation.

Radical orchiectomy: When your urologist performs a “radical” orchiectomy, he removes the complete testis and the inguinal spermatic cord at the level of the internal inguinal ring via an inguinal approach. You have two choices for a radical orchiectomy, based upon your surgeon’s approach:

• 54530 (Orchiectomy, radical, for tumor; inguinal approach) for an inguinal (through the groin) approach
• 54535 (Orchiectomy, radical, for tumor; with abdominal exploration) including an intra-abdominal examination.

Don’t miss: If you look at the code descriptors for 54530 and 54535, you will see that 54530 does not involve abdominal exploration but 54535 does.

Your urologist will usually perform a radical orchiectomy via an inguinal approach for malignant disease of the testicle such as a testicular cancer, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.

Simple orchiectomy: When your urologist performs a simple orchiectomy, he will remove one or both testicles at the distal spermatic cord, usually through an anterior trans-scrotal approach. You should report this procedure using code 54520 (Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach). Your urologist will usually perform a simple orchiectomy for nonmalignant testicular disease such as an ischemic testicle after prolonged testicular torsion or chronic inflammation, severe undiagnosed testicular or scrotal pain, testicular trauma with testicular laceration, or crush injuries of the testicle, according to Ferragamo.

Laparoscopic orchiectomy: When your urologist performs a laparoscopic orchiectomy, you should report code 54690 (Laparoscopy, surgical; orchiectomy).

Partial orchiectomy: A partial orchiectomy preserves the testicle for a patient who has a tumor that can be removed without removing the total or complete testicle. A partial orchiectomy is technically more sophisticated than a total orchiectomy. For a partial orchiectomy you’ll report code 54522 (Orchiectomy, partial).

Don’t miss: You should not report a partial orchiectomy by using 54520 with modifier 52 (Reduced services) appended. For years, this was your only option, but then CPT^® introduced code 54522. So, now 54522 is the more accurate choice for a partial orchiectomy.

Tip 3: Puzzle Out These Orchiectomy Scenarios

Your urologist may need to biopsy a suspected tumor before he performs an orchiectomy. Take a look at the different coding scenarios you may encounter when reporting an orchiectomy in your practice.

Scenario 1: Your urologist questions whether a malignant tumor exists. The patient has normal blood markers, but an area of calcification is palpable in the testicle. Your urologist performs a biopsy after clamping the cord and walling off the surgical field. Your urologist then sends the specimen to the lab for a stat, frozen, analysis.

If the patient’s biopsy is positive, then your urologist would perform a radical orchiectomy, which you would report with code 54530. You should also report the appropriate code for the biopsy. If your urologist performs a needle biopsy, you should report 54500 (Biopsy of testis, needle (separate procedure)) along with 54530. No National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits exist between codes 54530 and 54500, so you can report both codes on your claim without a modifier.

On the other hand, if your urologist performs an incisional biopsy, 54505 (Biopsy of testis, incisional (separate procedure)), this service is bundled into 54530. You should report 54505-59 (Distinct procedural service) in addition to 54530 for a radical orchiectomy and an incisional testicular biopsy. Your physician should also be paid for the biopsy as well as the orchiectomy because the biopsy was necessary to determine subsequent treatment.

Scenario 2: Your urologist diagnoses the patient with cancer preoperatively by performing a clinical exam, sonography, and a blood test. Your urologist chooses to proceed to the orchiectomy without a biopsy. They remove the testicle using an inguinal approach.

You should report the following codes on your claim:

• 54530 for a radical orchiectomy. Note: If your urologist performs this procedure bilaterally, you should report 54530 with modifier 50 (Bilateral procedure).
• 76870 (Ultrasound, scrotum and contents) for the sonography performed in an office. Note: If performed by your urologist at surgery, you should report 76998 (Ultrasonic guidance, intraoperative) with modifier 26 (Professional component) appended for only the physician’s interpretation of the study, Ferragavmo says.

Scenario 3: Your urologist suspects testicular cancer, so he biopsies the tumor in the operating room (OR) at the time of the testicular exploration before deciding on treatment. The biopsy is negative, so your urologist does not need to perform an orchiectomy.

In this case, if the in-surgery biopsy is benign, your urologist will replace the testicle into the scrotum and close the wound. You should report 54530 with modifier 52 to indicate a lesser procedure: an inguinal approach and mobilization of the testicle without orchiectomy. You should also report the biopsy with 54500-51 (Multiple procedures) or 54505-59-51.