Urology Coding Alert

Reader Question:

Excision of Sperm Granuloma

Question: How do we code for excision of sperm granuloma? CPT 55450 (ligation [percutaneous] of vas deferens, unilateral or bilateral [separate procedure]) does not work for our carriers.

Ohio Subscriber

Answer: Spermatic granulomas can be caused by extravasation of sperm from damaged epididymal tubules. The granuloma sometimes develop after a patient has undergone a vasectomy, causing testicular pain. Correct code selection is based on the location of the granuloma. Use codes 10120-10121 (incision and removal or foreign body, subcutaneous tissues) if the granuloma is within the subcutaneous tissues. If the granuloma is attached to the epididymis, a deeper incision is necessary and you would use 54830 (excision of local lesion of epididymis). Code 55450 is incorrect in this case because it is a sterilization procedure, not a procedure for removal of diseased portions of the spermatic cord.
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