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billing for inguinal hernia and spermatic cord lipoma

  1. #1
    Default billing for inguinal hernia and spermatic cord lipoma
    Medical Coding Books
    Hi Fellows,

    I just need your knowledge about these 2 procedures here. We have this case as the Dr operated a patient with an inguinal hernia and cord lipoma (49505 and 55520). As you can see in the cpt book the 55520 (excision of lipoma cord) is a separate procedure and supposedly not separately claimble, but if you look in the CCI edits, when you look under both the cpt they are not a compartment of each other. Unlike other codes in the CCI that it will tell you directly if the codes are paired or not. Does this mean that both of these procedures are 2 separate claimable? I billed Anthem with both procedure and included the op-report with the claim and they both paid it. Can you please give me your feed back. I really appreciate it.

  2. #2
    I code for 11 ASC's..If the documentation supports it, I code them as well.
    I have researched this in the past and have found no documentation to support that we can not.

    Hope this helps

  3. #3
    Thanks for the quick reply.

  4. Default
    I also code for an ASC & have been told in the past at seminars, that since the procedures are in 2 different systems of the body, meaning the hernia repair is in the Surgery/Digestive System and the spermatic cord lipoma removal is in the Surgery/Male Genital System (in CPT) then it's ok to code them together. Just wanted to give you that information.

    Happy coding!

  5. Default
    I haven't been coding for the cord lipoma excision. states:

    "Procedure 55520 is used to reort the excision of a lesion of the spermatic cord. This can be accomplished by a transverse incision in the scrotom in older children. However, in adults an inguinal approach is usually used. While perfoming an inguinal hernia repair, the surgeon makes an incision in the groin and dissects tissue to expose the hernia sac, internal olique muscle and the spermatic cord that runs beside it. At the time of the hernia repair, any lesions identified on the spermatic cord can also be excised. Thus, excision of a spermatic cord lesion is considered a component of the comprehensive hernia repair procedure. Therefore, Medicare denies procedure 55520 as a component of procedure 49505 when performed during the same operative session."

    I guess I'm confused about when it's okay to put a -59 modifier on something and get paid for it. In this case what makes the excision of the cord lipoma a "separate distinct service"? Is it the fact that the codes are in separate sections in the CPT manual?

  6. Default
    Keep in mind....same incision!?

  7. Default Inguinal hernia repair with lipoma of sperma cord excision
    You can charge for the lipoma sperma cord excision seperately from the inguinal hernia repair there is no concrete info stating otherwise. 55520 and 49505 no need to modify 55520. Hope this helps.

  8. #8
    I agree with ncantello

    it is included that would be up coding same incision during the hernia repair.

    if you must remove abnormal tissue and/or encounter something that must be corrected in order to complete the procedure it may be considered inclusive.

  9. Smile HIM Coder CPC-H
    Can you code for a clavectomy if the ORthopedic only excised 6-6mm. Thanks

  10. Smile HIM Coder CPC-H
    Can you code for a clavectomy if the ORthopedic only excised 5-6mm. Thanks

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