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Old 02-24-2010, 07:49 AM
kathyking kathyking is offline
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Unhappy Exc Abcess from scrotum...Anyone that can answer

Exc Abcess from scrotum, deep,at a ASC Facility

Hi,

I have tried to post a couple of times and it failed. Kind of new at this. So, please overlook typo's for this is going to be a rush job, been on here for awhile now.

Ok, we have been getting rejections from the ins using 55899 unlisted code for Excision of a abcess from the scrotum area, which was deep, deep, and it was sutured closed. (was not left open to drain)

Now, going by the AMA rules, if lesion is deeper than subcutaneous/etc use the Musculoskeletal area, but keep in the coding in the Anatomic area. (AMA CPT ASSISTANT Aug. 2006 volume 16, issue 8)

Now going into the male genital area in the CPT book there is 55150 but this is resection of the scrotum, not removal the scrotum in anyway partial/complete.

So, too deep to use the Integumentary System area. There isn't a code in the Male genital system area that suits this.

This is how we came up with using 55899.

Now coding it this way and sending the op notes, even did a appeal with other info attached, it is still getting rejected. Now, they did state there is a proper code for this, and that is my question,......

Does anyone know of a code that would better suit this?

PLease feel free to help me in any kind of way.

THANKS!!!
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Old 02-25-2010, 03:27 PM
FTessaBartels FTessaBartels is offline
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Default 54700

NOT my specialty but ...

Did you consider CPT 54700
Lay description from Encoder Pro:
The physician drains a collection of blood or an abscess within the scrotum. If the testis is the target of the drainage, it is held firmly with the scrotal skin stretched tightly over the testis and the epididymis positioned away from the site. A small incision is made through the skin of the scrotum. The underlying tissues are incised and dissected to expose the testis and the site to be drained. The testis may be stabilized by two sutures as an incision is made into the abscess or hematoma and fluid is expressed. Packing or a rubber drain may be placed to promote drainage. The incisions are usually not closed by suturing. Similar procedures are followed if the target is the epididymis or the scrotal space.


I know that it says that the incisions are usually NOT closed by suturing, but perhaps you can add a -22 modifier for the additional work?

Hope that helps.

F Tessa Bartels, CPC, CEMC
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Old 02-25-2010, 06:44 PM
eadun2000 eadun2000 is offline
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Quote:
Originally Posted by FTessaBartels View Post
NOT my specialty but ...

Did you consider CPT 54700
Lay description from Encoder Pro:
The physician drains a collection of blood or an abscess within the scrotum. If the testis is the target of the drainage, it is held firmly with the scrotal skin stretched tightly over the testis and the epididymis positioned away from the site. A small incision is made through the skin of the scrotum. The underlying tissues are incised and dissected to expose the testis and the site to be drained. The testis may be stabilized by two sutures as an incision is made into the abscess or hematoma and fluid is expressed. Packing or a rubber drain may be placed to promote drainage. The incisions are usually not closed by suturing. Similar procedures are followed if the target is the epididymis or the scrotal space.


I know that it says that the incisions are usually NOT closed by suturing, but perhaps you can add a -22 modifier for the additional work?

Hope that helps.

F Tessa Bartels, CPC, CEMC

I think the code is fine as it says "usually NOT closed by suturing. I see that as sometimes it is, but mostly is not. When I look up the code in the CPT it states " Incision and drainage of epididymis, testis and/or scrotal space (eg. abscess or hematoma) I think this fits
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