Urology Coding Alert

Question: An adult patient presented for left inguinal hernia repair. The patient was taken to the operating room, where a left groin incision was made. Dissection was carried down through Scarpa’s fascia to the external oblique fascia, which was opened. The spermatic cord and its contents were mobilized up to the internal ring, revealing a direct defect. No indirect hernia sac was found. A moderate-sized cord lipoma was dissected away from the cord structures, ligated and excised. The inguinal floor was opened; the preperitoneal space bluntly developed. Mesh was secured to the pubic tubercle and tacked to the rectus. A slit was made in the mesh and the two cut edges encircled around the spermatic cord, creating a new internal ring. The spermatic cord was then returned to its anatomic position. The wound was closed in layers; Steri-strips and a sterile dressing were placed. The patient was extubated and in stable condition. Can we report CPT^® code 55520 for the excision of the spermatic cord lipoma via the same incision as the hernia repair since the hernia repair and lipoma excision are from two different body systems?

Alaska Subscriber

Answer: In this case, you should assign CPT^® code 55520 (Excision of lesion of spermatic cord (separate procedure) with modifier 59 (Distinct procedural service) appended for the excision of the lipoma. Although CPT^® designates 55520 as a separate procedure, the medical record documentation supported the cord lipoma removal, and this was distinct and not inherent to the hernia repair. The provider removed the lipoma from the urinary tract and the hernia repair was in the abdomen; therefore, you may report the lipoma excision separately. This is consistent with CPT^®’s “Separate Procedure” guideline and the National Correct Coding Initiative (NCCI) policy manual that advises modifier 59 may be appended to indicate a procedure or service was distinct and independent, including representing a different lesion or organ system.

You should also report the primary service of the hernia repair. According to Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager at MRO in Philadelphia, “Surgeons often do not include in their documentation enough detail for us to select a diagnosis code, so query the surgeon regarding incarceration and gangrene, and whether it is definitive to choose an appropriate code.”