Urology Coding Alert

Question: In reference to the varicocelecomy (CPT 55530 ) which is an excision of varicocele or ligation of spermatic veins, how many veins are usually ligated? I have a report that indicates 10 veins were ligated. If 10 is more than usual I would append a 22, however; I am not sure if 10 is more than usual.

Answer: There is really no set number of veins ligated during a varicocelectomy, which you report with 55530 (Excision of varicocele or ligation of spermatic veins for varicocele; [separate procedure]).

You may consider adding modifier 22 (Increased procedural services) if the extra ligation of veins did significantly prolong the procedure or make the surgery more complicated. The surgeon would be the best one to determine this. Often the extra vein ligation does not really prolong the surgery or complicate the general procedure.