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Urology Coding Alert

Location, Condition Drive Orchiopexy and Hernia Repair

Published on Fri Feb 01, 2002

Urologists occasionally perform an orchiopexy and hernia repair at the same session. Code selection depends on the location of the hernia and testicle, and their condition.

Orchiopexy

Undescended testis: This is the most common scenario for a laparoscopic orchiopexy, frequently performed on a young child with an undescended testicle. For moving the intra-abdominal undescended testicle down laparoscopically, report CPT 54692 (Laparoscopy, surgical; orchiopexy for intra-abdominal testis), recommends Michael A. Ferragamo, MD, professor of urology at the State University of New York, Stony Brook. Use ICD9 752.51 (Undescended and retractile testicle; undescended testis) for an undescended testicle.
 
If performing an open orchiopexy for undescended testicle, report 54650 (Orchiopexy, abdominal approach, for intra-abdominal testis [e.g., Fowler-Stephens]).
 
A laparoscopic approach is rarely used for an undescended testicle located within the inguinal canal. Use 54692, says Cynthia Jackson, RRA, CPC, a coding auditor based in Atlanta. Code 54640 (Orchiopexy, inguinal approach, with or without hernia repair) is inappropriate because it describes an open, not a laparoscopic, approach.
 
Exploration: When an inguinal or abdominal exploration fails to reveal a testicle, as in absent testicle syndrome (752.8, Other specified anomalies of genital organs), use 54550 (Exploration for undescended testis, inguinal or scrotal area) or 54560 (Exploration for undescended testis with abdominal exploration). When an inguinal or abdominal exploration constitutes the major procedure and a small atrophic testicle (608.3, Atrophy of testis) is discovered and removed, report 54560 and 54520 (Orchiectomy, simple [including subcapsular], with or without testicular prosthesis, scrotal or inguinal approach) with modifier -51 (Multiple procedures) appended, Ferragamo says.
 
Retractile testis: Orchiopexy must occasionally be performed transcrotally for a retractile testis (a testis that moves up and down). Use 54600 (Reduction of torsion of testis, surgical, with or without fixation of contralateral testis) with modifier -52 (Reduced services) appended because torsion reduction is not performed. Link 752.52 ( retractile testis).
 
Ectopic testis: The testis has sometimes descended but not in the normal path. Instead of residing in the scrotum, it leaves the external inguinal ring, and descends pathologically into the perineum, the penis, the femoral area, or the subcutaneous pouch of Douglas. Use 54640 for this repair, with 752.51, the diagnosis code specified for ectopic testis. 

With Hernia Repair

Code hernia repairs performed alone with 49491-49659. For most laparoscopic hernia repairs report 49650 (Laparoscopy, surgical; repair initial inguinal hernia) or 49651 ( repair recurrent inguinal hernia).
 
Hernia repair performed with orchiopexy would most often be on the contralateral side. An intra-abdominal undescended testicle is not usually associated with an accompanying hernia. The lack of a hernia, in fact, may be one reason the testicle did not descend, Ferragamo says.
 
Assuming that the hernia is initial and not recurrent, bill 49650 for the hernia repair, and 54692 for the orchiopexy. Bill 54692 on the first line, and 49650 with modifier -51 appended, on the second line, because 54692 has a relative value unit (RVU) of 19.59, compared to 10.24 for 49650. Use 550.90 (Inguinal hernia, without mention of obstruction or gangrene; unilateral or unspecified [not specified as recurrent]) for the hernia repair, and 725.51 for the orchiopexy. Add modifiers -LT (Left side) and -RT (Right side) to the appropriate code. (This is optional because both code descriptors are unilateral and neither is bundled in the other, but using modifiers -LT and -RT would more fully describe the procedures performed.)
 
The urologist may be able to use the same ports for both laparoscopic procedures. This has no effect on the coding.
 
Diagnosis codes for hernias are broken down by site; urologists typically use the inguinal hernia diagnosis codes (550.9x for those with no obstruction or gangrene). Diagnosis codes for undescended testicles are not broken down by site.

With or without Hernia Repair

Coders may find the "with or without hernia repair" verbiage in 54640 confusing when coding an orchiopexy and a hernia repair. Code 54640 describes an inguinal approach for an open orchiopexy. A parenthetical note under 54640 in CPT states: "For inguinal hernia repair performed in conjunction with inguinal orchiopexy, see 49495-49525." Therefore, when performing an inguinal orchiopexy and concurrent hernia repair, report 54640 and the appropriate hernia repair code (49495-49525) with modifier -51 appended to the hernia repair code.

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