Urology Coding Alert

Remember: If your provider performs the procedure bilaterally, append a modifier.

When your urologist performs procedures on the seminal vesicles, you should confirm details in the documentation, including whether they performed an incision or excision. This important detail will dictate your code choice.

Read on to learn how to always submit clean seminal vesicle claims in your practice.

Understand What Seminal Vesicles Are

The seminal vesicles are a pair of glands that secrete semen, the fluid containing sperm. The seminal vesicles are sac-like pouches that attach to the vas deferens near the base of the bladder.

The fluid of the seminal vesicles makes up most of the volume of ejaculatory fluid.

When a patient experiences seminal vesicle inflammation, they will have pain or swelling in the lower left section of their abdomen. As a result of seminal gland obstruction due to an inflammation, the seminal fluid will not be released.

Focus on 2 Codes for Seminal Vesicle Incision

Sometimes your urologist may perform a vesiculotomy, which is a surgical cut in the seminal vesicles. Their approach can be an incision either into the lower abdomen or the perineum between the anus and the scrotum.

When your urologist performs a vesiculotomy, you can either report 55600 (Vesiculotomy) or 55605 (Vesiculotomy; complicated).

Code 55600: Report 55600 if your provider performs a simple, uncomplicated vesiculotomy.

Code 55605: Report 55605 if your provider performs a complex dissection due to scar tissue in the area.

Don’t miss: Codes 55600 and 55605 represent a unilateral service, meaning they are performed on one side. If your provider performs these procedures bilaterally, you should append modifier 50 (Bilateral procedure) or modifiers RT (Right side) or LT (Left side) to the code, depending upon your payer’s preference.

Turn to 1 Option for Vesiculectomy

In some cases, your urologist may need to perform a vesiculectomy, which is the removal of one of the seminal vesicles. Your urologist will usually perform an excision to remove a calculus or other obstruction, or due to a lesion or infection in the vesicles. The approach may either be through the lower abdomen or the perineum.

You should report a vesiculectomy with 55650 (Vesiculectomy, any approach), regardless of the approach.

Modifier alert: Code 55650 represents a unilateral service, meaning it’s performed on one side. If your provider performs this procedure bilaterally, you should append modifier 50 (Bilateral procedure) or modifiers RT (Right side) or LT (Left side), depending upon your payer’s preference.

Don’t miss: Although the terms “vesiculectomy” and “vesiculotomy” look very similar, they describe two very different types of procedures. A “vesiculectomy” refers to an excision of the seminal glands, while a “vesiculotomy” refers to an incision.

Rely on 55680 for Mullerian Duct Cyst Excision

In some cases, your urologist may need to excise a Mullerian duct cyst — a structure in the seminal vesicles that persists abnormally from the development period prior to birth.

You should report 55680 (Excision of Mullerian duct cyst) for the excision of a Mullerian duct cyst. Your urologist may excise the cyst using a lower abdominal or perineal approach.

Mulluerian duct cyst defined: The Mullerian duct normally regresses in utero, but it can sometimes leave a remnant that turns into a Mullerian duct cyst. A Mullerian duct cyst is considered a congenital abnormality. It is typically small and asymptomatic but can appear as a pelvic mass or cause obstructive and irritating urinary symptoms.

Don’t miss: Code 55650 may include either an open surgical excision or a laparoscopic/robotic approach for removal of the seminal vesicle, explains Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.