Urology Coding Alert

Reviewed on May 27, 2015
  Hernias complicate coding for treatment of hydroceles, spermatoceles or varicoceles. Urologists must consider the type of hernia as well as the age of the patient in coding these multiple procedures.
     
A hydrocele is an accumulation of excessive fluid around the testicle between the parietal and visceral layers of the tunica vaginalis. The hydrocele fluid is drained and the tunica vaginalis partially excised. Some tissue is left and sutured together behind the spermatic cord. Code removal of a hydrocele with 55040 (Excision of hydrocele; unilateral) if on one side and 55041 (... bilateral) if on both sides.
     
A spermatocele is a cyst in the area between the epididymis and the testis. The urologist excises the spermatocele with or without a partial excision of the head of the epididymis. Code removal of a spermatocele with 54840 (Excision of spermatocele, with or without epididymectomy).
     
A varicocele is a dilation of the veins in the spermatic cord into the scrotum. Code removal of a varicocele using 55530 (Excision of varicocele or ligation of spermatic veins for varicocele; [separate procedure]). (The separate procedure indication in CPT® means that the procedure, such as a varicocelectomy, is often integral to a more comprehensive procedure such as a hernia repair.)
  
Bilateral Billing  
Codes 55530 and 54840 both carry a bilateral indicator of 1, which means you may report this code bilaterally using modifier 50 (Bilateral procedure).
 
There are separate codes for unilateral hydrocelectomy (55040) and bilateral hydrocelectomy (55041).
Hydrocelectomy and Hernia Repair
A hydrocele commonly occurs with a hernia. In pediatrics the two are so similar that the procedures are bundled. ""A hydrocele is the same as a hernia in pediatrics "" says Arthur Tarantino MD a urologist with Connecticut Surgical Group in Hartford, Conn. "The mechanism and the approach are similar for both." However, this is not true for an adult with a hernia and a hydrocele. 
 
Sometimes the general surgeon in the course of a hernia repair discovers a hydrocele and asks a urologist to repair the hydrocele. That coding scenario is simple: If the urologist performs only the hydrocelectomy and not the hernia repair bill 55040 with LT (Left side) or RT (Right side) appended to indicate left side/right side.
 
Sometimes the urologist assists the general surgeon in the hernia repair and hydrocelectomy. According to recent CPT® rules an assistant surgeon is a payable service with adult hernia repairs but not with hydrocelectomies. If the urologist assists in both and the patient is [...]