Urology Coding Alert

Question: I seem to have issues when I try to code for orchidopexies. Is an orchiopexy and orchidopexy the same thing? What code do I use for an orchiopexy? Here is one that I am trying to do now: 

Preoperative diagnosis:  Suspected left testicular torsion of 24 hours duration
Postoperative diagnosis: Documented left testicular torsion and necrotic left testicle
Operation: Left low inguinal orchiectomy, right trans-scrotal orchiopexy

Procedure: A 5 cm left low inguinal high scrotal incision was made. Subcutaneous tissue was dissected. The spermatic cord was isolated at the level of pubic tubercle by placing a right angle behind the spermatic cord, and placing a Penrose drain behind it. Blunt and sharp dissection were then used to deliver the testicle into the wound. The testicle was noted to be stuck to the anterior wall of the scrotum, which was severely thickened. Once the scrotum was delivered in the wound, the tunica vaginalis was incised, and a black and necrotic testicle was identified, with classic testicular torsion, with 3 circumferential wraps of the testicle around the spermatic cord. Was elected to proceed with orchiectomy, and therefore, the spermatic cord was dissected by isolating and double clamping the vas and incising it, and ligating with 3-0 Vicryl suture, and then isolating and double clamping the vasculature to the cord with Kelly clamps, and 0 Vicryl suture. The testicle was removed, and sent to pathology. Approximate 500 mL of saline was used to irrigate the scrotum. The remaining tissues appeared to be pink and viable. No abscess was identified. It was elected to close the wound primarily, therefore, the wound was closed in 2 layers using 3-0 Vicryl suture and 4-0 Vicryl suture. Skin was sealed with Dermabond. At the end of that procedure, mesh pants and Kerlix were used to put pressure on the wound, and ice was placed in recovery room. Note that the spermatic cord was injected with 2.5% plain Marcaine with epinephrine 1 200,000. The wound edges were also injected, as was the scrotum.

Attention was then directed to the right hemi-scrotum. A 4 cm horizontal incision is made along the skin edge, and the subcutaneous tissues were dissected. The testis was delivered into the wound. The tunica vaginalis was opened, and a normal pink testicles identified with a normal epididymis. The appendix epididymis is removed using the electrosurgical unit.

A 3 point fixation is accomplished with 3-0 PDS sutures in the right lateral, medial, and inferior portions of the wound and then sutured to the testicle. The wound was then closed in 2 layers using 3-0 Vicryl and 4-0 Vicryl suture. Dermabond was used on the skin. It is noted that the wound edges were injected with Marcaine and epinephrine.

North Carolina  Subscriber

Answer: Yes, orchiopexy and orchidopexy are the same.

Report the following coding for this clinical scenario:

• 54520 with modifier LT (Left side) appended for the orchiectomy. Use ICD-10 code N50.8 (Other specified disorders of the male genital organs).  
• 54620 with modifier RT (Right side) attached for the contralateral trans-scrotal testis fixation (orchiopexy). Attach diagnosis codes N44.02 (Torsion of spermatic cord NOS) and Z41.8 (Encounter for other procedures for purposes other than remedying health state).

In contrast to the above coding, an orchiopexy for a congenital undescended testicle (Q53.10), should be reported with code 54640 (Orchiopexy, inguinal approach, with or without hernia repair).

Tip: You can also bill for a hernia repair if your urologist performed the repair along with the orchiopexy, which happens about three quarters of the time with congenitally undescended testicles. In those cases, you should also bill for the hernia repair using the appropriate code from the 49495-49525 range, according to the age or other clinical findings.