Outpatient Facility Coding Alert

Published on Fri Aug 23, 2013 PDF

Question: What is the difference between 54700 and 55100?

Answer: In 54700 (Incision and drainage of epididymis, testis and/or scrotal space [eg, abscess or hematoma]), the surgeon examines the scrotum and scrotal space for location of the fluid collection. Then, the scrotum is incised and abscess or hematoma is located in the scrotal space and using blunt dissection pus is drained. If the location of fluid is in the testis, then the epididymis is positioned away and a small incision is made through the skin of the scrotum. The underlying tissues and tunica vaginalis is opened and incised, which exposes the testis and abscess or hematoma is drained. Similarly, if the abscess is in the epididymis, it is exposed and drained in similar manner. Drain is placed to allow drainage of the remaining material.

In 55100 (Drainage of scrotal wall abscess), the surgeon makes an incision into scrotal wall where the abscess is present after giving local anesthesia. The pus is removed and abscess cavity is irrigated with saline or antibiotic solution. The incision may be left open and packed with gauze and drain is placed.

You should report 54700 for the drainage of the hematoma. Payers will include the scrotal exploration (55110) with this CPT^® code. The Correct Coding Initiative (CCI), however, bundles these two procedures with an edit, and the modifier indicator of 0 (zero) indicates that there are no circumstances in which a modifier would be appropriate.