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re: Inguinal Hernia repair and spermatic cord lipoma Would it be appropriate to report code 55520, Excision of lesion of spermatic cord (separate procedure), in addition to an inguinal hernia repair code (eg, 49505)? Code 55520, Excision of lesion of spermatic cord (separate procedure), is designated as a "separate procedure."
The procedure code 0YQ50ZZ is in the medical and surgical section and is part of the anatomical regions, lower extremities body system, classified under the repair operation. The applicable bodypart is inguinal region, right.
At the time of the hernia repair, any lesions identified on the spermatic cord can also be excised. Thus, excision of a spermatic cord lesion is considered a component of the comprehensive hernia repair procedure.
While perfoming an inguinal hernia repair, the surgeon makes an incision in the groin and dissects tissue to expose the hernia sac, internal olique muscle and the spermatic cord that runs beside it. At the time of the hernia repair, any lesions identified on the spermatic cord can also be excised.
As you can see in the cpt book the 55520 (excision of lipoma cord) is a separate procedure and supposedly not separately claimble, but if you look in the CCI edits, when you look under both the cpt they are not a compartment of each other.
A lipoma of the cord is herniated fat that appears to originate from the retroperitoneal fat outside and posterior to the internal spermatic fascia and protrudes through the internal ring lateral to the cord. They are generally not visible by transperitoneal inspection unless manually reduced.
If the lipoma were located superficially, the removal of the lipoma would be coded to excision of a benign lesion. The appropriate code would fall into the CPT code range 11400-11446 based on location and size of the lipoma removed.
Code 55520, Excision of lesion of spermatic cord (separate procedure), is a “separate procedure.”
Lipomas of the cord (in men) and round ligament (in women) represent a simple protrusion (or herniation) of pedunculated extra-peritoneal fat through the inguinal canal. They are quite common and since their blood supply originates from the preperitoneal space, can be simply reduced without the need to be excised [1].
Results: Spermatic cord lipoma seems to originate from preperitoneal fatty tissue within the internal spermatic fascia in topographical proximity to the arteries, veins, lymphatics, nerves, and deferent duct within the spermatic cord. Reliable diagnosis cannot be made clinically, but rather with ultrasound, CT, or MRI.
D17.6ICD-10 code D17. 6 for Benign lipomatous neoplasm of spermatic cord is a medical classification as listed by WHO under the range - Neoplasms .
214.1 - Lipoma of other skin and subcutaneous tissue | ICD-10-CM.
Per the American College of Surgeons you should use the Thorax 21555 - 21554 for the Axilla.
The spermatic cord is the cord-like structure in males formed by the vas deferens (ductus deferens) and surrounding tissue that runs from the deep inguinal ring down to each testicle....Spermatic cordLatinFuniculus spermaticusMeSHD013085TA98A09.3.04.001TA236156 more rows
CPT code 49568 is an add-on code describing implantation of mesh or other prosthesis for incisional or ventral hernia repair. This code may be reported with incisional or ventral hernia repair CPT codes 49560-49566.
For example, a laparoscopic low anterior resection with loop ileostomy (44208) will be counted as a Low anterior resection, a Laparoscopic case, a Pelvic dissection, and a Stoma creation.
You might consider using the XS modifier as the spermatic cord is part of the male reproductive system and not the muscular system or abdominal area. The only issue we have with this is when the hernia repair is laparoscopic because there is not a lap code for the removal of a spermatic cord lesion and we have to use the unlisted code for ...
In my opinion, the modifier 59 would not be appropriate unless the excision of the lesion was performed through a separate incision or during a separate operative session from the hernia repair.#N#The bundling edit on these two procedures is based on the CPT 'separate procedure' designation on CPT code for the excision of spermatic code lipoma. Per CPT instructions, a code with this designation is one that is " commonly carried out as an integral component of a total service or procedure" and should only be reported separately with a modifier when it is"a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separateincision/excision, separate lesion, or separate injury (or area of injury in extensive injuries)."#N#Cord lesions are very commonly removed during many inguinal hernia repair surgeries, and billing routinely as a separate procedure would be considered inappropriate unbundling unless the documentation supports it is distinct from the main procedure and medically necessary as a separate surgery.