Spermatocelectomy w/wo Epididymectomy

ckkohler

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Hello!
When faced with a spermatocelectomy (54840) and needing to perform an epididymectomy (54860) due to significant scar tissue preventing the spermatocelectomy...what criteria do you look for to know when it is OK to code both 54840 and 54860 and when it should NOT be OK? According to CCI edits and Coding Today - they are not considered bundled ... but, the description of 54840 states "excision of spermatocele with or without epididymectomy.

Thanks in advance!
 

JEYCPC

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To me, it looks like in 54840 taking out the epididymis is incidental. They are there anyway so they can take it out easily. 54860 for epididymectomy is if they are going specifically for the epididymis. I would only code both if there were documentation stating a specific problem with the epididymis. Not just that it was scar tissue. Look at it like this, lysis of adhesion is part of a procedure, you only bill for it separately if the only reason you are there is for the adhesion.
 
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New Braunfels, TX
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To me, it looks like in 54840 taking out the epididymis is incidental. They are there anyway so they can take it out easily. 54860 for epididymectomy is if they are going specifically for the epididymis. I would only code both if there were documentation stating a specific problem with the epididymis. Not just that it was scar tissue. Look at it like this, lysis of adhesion is part of a procedure, you only bill for it separately if the only reason you are there is for the adhesion.

I concur. I might put a modifier -22 on CPT if the documentation supports it by saying something like, "the lysis of adhesion extended the surgery by an hour." I hope this helps!
 

ckkohler

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Thank you BOTH very much. I went ahead and billed both - but, I "get" what you're saying in the example of adhesion lysis. Will make note for the future. Thank you so very much!
 
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