Ob-Gyn Coding Alert

Question: The patient was a 17-year-old female with incomplete androgen insensitivity syndrome. Laparoscopy revealed there was a gonad-testicle sitting where the round ligament would have entered the abdominal wall. The testicular vessels were skeletonized, bipolared and cut. The ob-gyn removed the testicle on the right and left side. We reported this with the diagnosis of 259.5, but which CPT codes should I use?


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Answer: You should consider this a partial orchiectomy (54522, Orchiectomy, partial, for the open procedure, or 54690, Laparoscopy, surgical; orchiectomy, if performed laparoscopically).

Keep in mind: You will more than likely hit the gender/procedure barrier if you use this code. Your best bet is to go with an unlisted-procedure code (58999, Unlisted procedure, female genital system [nonobstetrical], if the ob-gyn performs the procedure through an abdominal incision, or 49329, Unlisted laparoscopy procedure, abdomen, peritoneum and omentum, if performed with a laparoscope) and then send in the explanation. This will probably get you paid faster.