Wiki Separate Procedure 55520+49505

[GuzmanS]

It is my understanding that 55520 (Excision of lesion of spermatic cord (separate procedure)) is not billable with an inguinal hernia repair. The NCCI edits do not show any bundling issues, however, it's listed as a separate procedure which indicates that it is not normally billed separately with another procedure.

Am I right about this rule, or can I bill 55520 with 49505?

Thank you for your help!

 

[nsteinhauser]

Per CPT Assistant, September 2000, Vol 10 Issue 9

"Code 55520, Excision of lesion of spermatic cord (separate procedure), is designated as a "separate procedure." Codes with the "separate procedure" designation normally would not be additionally reported when the procedure or service is performed as an integral component of another procedure or service. However, when codes designated as "separate procedures" are performed independently, unrelated or distinct from other procedure(s)/service(s) provided, then it would be appropriate to separately report the separate procedure. Modifier '-59,' Distinct Procedural Service, would be appended to code 55520 to indicate that the excision of the spermatic cord lesion is a separate, distinct procedure from the inguinal hernia repair performed at the same surgical session."

So based on the above, I do code the 55520 - 59 with the inguinal hernia repair. Do all payers pay it? No. But until there is documentation somewhere to overturn the above, I will still code it.

Hope this helps.