Urology Coding Alert

Question: How should I code a right scrotal orchiectomy for missed torsion performed at the same time as a left orchiopexy? And how should I bill this for a patient with private-pay insurance?

Kentucky Subscriber

Answer: The first thing you should consider when coding the above scenario is the approach used to perform the orchiectomy a scrotal approach.

Of the orchiectomy codes (54520-54535), codes representing the surgical removal of the testes, only one code, 54520 (Orchiectomy, simple [including subcapsular], with or without testicular prosthesis, scrotal or inguinal approach), indicates a scrotal approach. The information you provided does not indicate any factors complicating the procedure, suggesting that the procedure was "simple," a descriptor also included in code 54520.

As for the left orchiopexy, fixation of an excessively mobile testicle into the scrotum, you should use 54620 (Fixation of contralateral testis) with modifier -51 (Multiple procedures).

When billing a private carrier, you may need to use alpha modifiers, -RT and -LT, to indicate to the carrier that the procedures were performed on separate sides of the urinary system. Link the pathology with the specific site involved and send a copy of the latest National Correct Coding Initiative (NCCI) edits to show the carrier that 54520 and 54620 are not bundled together. These measures will help you to convey to the carrier that the fixation should not be considered a part of the testis removal because the two procedures were not performed on the same testis.