Urology Coding Alert
Check Medical Documentation for Biopsy Details
Question: My surgeon performed a testicle biopsy, frozen section intraoperative. The results came back as cancer, so my physician performed a radical orchiectomy. Can I bill 54505 with 54530? I thought I read somewhere that I could do this, but I’m not sure. AAPC Forum Member Answer: How you code this clinical scenario will depend on how your physician did the biopsy. For an incisional biopsy of the testicle, you should report codes 54530 (Orchiectomy, radical, for tumor; inguinal approach) and 54505 (Biopsy of testis, incisional (separate procedure)-XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service). For a needle biopsy of the testicle, you should report codes 54530 and 54500 (Biopsy of testis, needle (separate procedure)) without a modifier.
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