Urology Coding Alert

Question: What is the correct code(s) to use for bilateral testicular fixation for intermittent testicular torsion? At the time of the surgery, the patient was symptom-free. The descriptor for CPT 54600 makes me think the testis needs to currently be in torsion. CPT 54620 works, but applies to one side, not both.

Kansas Subscriber

Answer: You should report 54620-50 (Fixation of contralateral testis [separate procedure]; bilateral  procedure) for the bilateral trans-scrotal orchiopexy for recurrent torsion. The patient does not need to be experiencing symptoms at the time of surgery.

Modifier help: You can append modifier 50 to 54620 to indicate that this procedure can be performed bilaterally even though the CPT code description for 54620 seems to contradict this.

When dealing with non-Medicare payers, you should ask your insurers how they want you to report bilateral procedures -- whether to use modifiers 50, LT/RT (Left/Right side), or both together.

Some insurers will specify when they prefer modifier 50 and when they require modifiers LT/RT. Other payers prefer modifiers LT/RT in all circumstances because they think those modifiers are more specific than modifier 50.

Even when requiring modifier 50, some payers have different ways that they want you to report the services. Some carriers might prefer you to report your procedure code using two line items, appending modifier 50 to the second code (such as 54620, 54620- 50). Other carriers might want the code reported only once, with modifier 50 appended (such as 54620-50).

Protect yourself: Always be sure to get the payers' coding recommendations and payment guidelines in writing in the event of audits or claim reviews, coding experts say.