Urology Coding Alert

Urologists commonly perform inguinal orchiopexies and hernia repairs in the same surgical session, but it's less common to find coders confident in their ability to get paid for both procedures.

Orchiopexy is the treatment of freeing an undescended testicle and implanting it into the scrotum. Orchiopexies are also performed for retractile testes of increased mobility that move up and down within the inguinal canal and the scrotal sac, and for ectopic testes that have not descended properly and lie in an abnormal location. Undescended testicles are often associated with an indirect inguinal hernia on the same side. Both abnormalities will require repair at the same sitting.

The confusion about coding orchiopexies and hernia repairs stems from the inclusion of "with or without hernia repair" in the CPT descriptor of 54640 (Orchiopexy, inguinal approach, with or without hernia repair), which could be interpreted as implying that hernia repair is included in the code. But a statement following the descriptor further complicates matters, saying, "for inguinal hernia repair performed in conjunction with inguinal orchiopexy, see 49495-49525." So should you report an additional code for the hernia repair, or is the hernia repair accounted for by 54640?

According to a letter from the American Medical Association's CPT Codes Information Services, the statement subsequent to the descriptor for 54640 was added to "allay misinterpretation that inguinal hernia repair is an inclusive procedure of the orchiopexy procedure (54640)." The letter instructs coders to report "both code 54640 and the appropriate inguinal hernia repair code" when a hernia repair is performed in addition to an orchiopexy.

When some insurance carriers deny the combination of the hernia repair and orchiopexy repair codes on initial processing, it is a good idea to request a review with supporting documentation, says Karen Delebreau, coding specialist with Baycare Clinic Urological Surgeons in Green Bay, Wis.

And don't forget that you will need to append modifier -51 to the hernia repair code to indicate that multiple procedures were performed during the single surgical session. Modifier -51 is appended to the hernia repair code and not the orchiopexy code because the orchiopexy has the higher relative value units (RVUs) and should be paid in full.

Use the flowchart in article 3 as your guide to coding orchiopexies and hernia repairs.