Urology Coding Alert

Question: If my doctor performs an inguinal hernia repair and an orchiopexy in the same surgical session, can I report both? I'm confused because the description of the orchiopexy code 54640 says "with or without hernia repair." And this statement follows the descriptor: "For inguinal hernia repair performed in conjunction with inguinal orchiopexy, see 49495-49525." So should I report an additional code for the hernia repair, or does 54640 account for the hernia repair?

Alabama Subscriber

Answer: Report both procedures. "When both orchiopexy by inguinal approach (54640) and inguinal hernia repair (49495-49525) are performed, both procedures should be reported separately," according to the AMA's CPT Assistant, January 2004, Volume 14, Issue 1, page 27.

"The parenthetical note clarifies that when an inguinal hernia repair is performed in conjunction with inguinal orchiopexy, the coder should also see (and use) codes 49495-49525."

Assuming that the hernia is initial and not recurrent, bill 49505 (Repair initial inguinal hernia, age 5 years or over; reducible) or 49507 (... incarcerated or strangulated) for the hernia repair, and 54640 (Orchiopexy, inguinal approach, with or without hernia repair) for the orchiopexy.

Don't forget that for non-Medicare carriers you will need to append modifier -51 (Multiple procedures) to the hernia repair code to indicate that multiple procedures were performed during the single surgical session. Append modifier -51 to the hernia repair code, not the orchiopexy code, because the orchiopexy has the higher relative value units and should be paid in full.

Diagnosis codes: Use 550.90 (Inguinal hernia, without mention of obstruction or gangrene; unilateral or unspecified [not specified as recurrent]) for the hernia repair, and 752.51 (Undescended and retractile testicle; undescended testis) for the orchiopexy.

The AMA added the "see 49495-49525" statement after 54640 to address the misinterpretation that orchiopexy is included in hernia repair. If a carrier denies the combination of the hernia repair and orchiopexy repair codes on initial processing, request a review with supporting documentation.

-- Answers to You Be the Coder and Reader Questions contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook, New York; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis.