Urology Coding Alert
'Unlisted' Is Your Only Choice for Scrotal Fistula Excision
Question: The urologist completed an excision of a scrotal fistula, scrotal exploration, and cystourethroscopy. I know the codes for the exploration and cystoscopy, but don't know what to choose for the scrotal fistula excision. What should I do? West Virginia Subscriber Answer: CPT® does not currently include a code specifically for excision of a scrotal fistula. Because of that, you should file with 55899 (Unlisted procedure, male genital system). Include a cover letter stating why you are reporting the "unlisted procedure" code with a clear explanation of exactly what the urologist did. Also report 55110 (Scrotal exploration) for the exploration and 52000 (Cystourethroscopy [separate procedure]) for the cystoscopy. Coding edits do not prevent you from reporting all three codes together. However, remember, many payers may consider the scrotal exploration part of your unlisted procedure depending on your operative report which they will review and then likely not reimburse for code 55110. Reimbursement for the cystoscopic examination will depend on the reason or diagnosis for the endoscopy.
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