Urology Coding Alert

There is a code for the excision or removal of a hydrocele, a sac filled with fluid that is in the spermatic cord. There is also a code for ligation, or tying, of a varicocele, an abnormally dilated vein in the spermatic cord. But what if the urologist ligates the hydrocele? Neither 55500 (excision of hydrocele of spermatic cord, unilateral [separate procedure]) nor 55530 (excision of varicocele or ligation of spermatic veins for varicocele; [separate procedure]) is appropriate. What code should you use for ligation of a hydrocele?

There are two possible solutions, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding and reimbursement firm based in Denver. One is to use 55899 (unlisted procedure, male genital system). The other is to use 55500, with a -52 modifier (reduced services) appended. In this case, the -52 modifier will result in a reduction in payment.

Whether you use 55899 or 55500-52, you will have to file a paper claim for this, says Page. You must submit the operative report with the claim. In addition, the physicians fee for this service should reflect an appropriate reduction of the regular charge.

It is not acceptable to file 55500 without a modifier when this procedure is done using the ligation technique.