Wiki billing for inguinal hernia and spermatic cord lipoma

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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.
 
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!
 
I haven't been coding for the cord lipoma excision.

www.floridamedicare.com/Part_B/_update/archive/107343.pdf 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?
 
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.
 
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.
 
AMA states 8-10mm of the distal clavicle should be excised. 6mm could possibly also support 23120. Most of the time 23125 is used to remove the whole clavicle for like diseased bone, osteomyelitis or carinoma, etc.

:)
 
I agree with MBORT. I bill them all the time. An article from BeckersASC.com January 25, 2011 issue, written by Lolita M. Jones, RHIA, CCS regarding "7 Common Surgery Center Coding Errors". She pulls this information from the July 2000 CPT Assistant stating "the AMA clarified that when a patient comes to the ASC for an inguinal hernia repair and a spermatic cord lipoma is excised in the same operative session, coders can assign a separate code for the spermatic cord lipoma". I would go back and see if you can bill for all the monies lost.

http://www.beckersasc.com/asc-codin...ns/7-common-surgery-center-coding-errors.html
 
Per CPT Assistant, September 2000 Page: 10 Category: Coding Consultation

Question

Would it be appropriate to report code 55520, Excision of lesion of spermatic cord (separate procedure), in addition to an inguinal hernia repair code (eg, 49505)?

AMA Comment

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.
 
According to the AMA CPT Section Guidelines: CPT code 55520
If the Excision of a lesion of the spermatic cord was performed as a DISTINCT Procedure and NOT as a
Component of 49505 inguinal hernia repair then is not Reportable.

CCI EDITS: HCPCS 55520/49505 Column 1/Column 2 Correct coding edits.
Code pair is accompanied by a modifier that is acceptable to the OCE but WOULD not
override the OCE/CCI edit according to the Standard coding practice.
HCPCS: (1) 49505/HCPCS (2) 55520
Just coded this one today...
Carol
 
CPT ASSIST: Lipomas of the spermatic cord do not present in more than 50% of hernia repairs, and therefore, the work of excision is not inherent to a hernia repair. A lipoma of the spermatic cord is just that - part of the cord and can be present with or without a direct or indirect hernia. It is important to make a clear distinction between pre-peritoneal fat that is adhered to or part of the hernia sac as opposed to a lipoma that is in the cord itself, and not part of the hernia sac, since the work of excision would be different. For a direct hernia, report code 55520, Excision of lesion of spermatic cord (separate procedure), with modifier 59, Distinct Procedural Service, appended in conjunction with the hernia repair code, as the work is part of two distinct systems; abdomen and urinary tract. In contrast, an indirect hernia is an extension of the peritoneum and as such usually has some pre-peritoneal fat stuck to the indirect hernia sac and code 55520 should not be separately reported because the pre-peritoneal fat is part of the hernia sac, and therefore, part of the hernia repair work
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bench said:
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.
Click to expand...
55520 is not reported on the Practicode question. 2/15/2024
 
carol52 said:
CPT ASSIST: Lipomas of the spermatic cord do not present in more than 50% of hernia repairs, and therefore, the work of excision is not inherent to a hernia repair. A lipoma of the spermatic cord is just that - part of the cord and can be present with or without a direct or indirect hernia. It is important to make a clear distinction between pre-peritoneal fat that is adhered to or part of the hernia sac as opposed to a lipoma that is in the cord itself, and not part of the hernia sac, since the work of excision would be different. For a direct hernia, report code 55520, Excision of lesion of spermatic cord (separate procedure), with modifier 59, Distinct Procedural Service, appended in conjunction with the hernia repair code, as the work is part of two distinct systems; abdomen and urinary tract. In contrast, an indirect hernia is an extension of the peritoneum and as such usually has some pre-peritoneal fat stuck to the indirect hernia sac and code 55520 should not be separately reported because the pre-peritoneal fat is part of the hernia sac, and therefore, part of the hernia repair work
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Click to expand...
Hi, You noted the above article was from CPT ASSIST but I can't seem to find it when I search under CPT 55520. This article very informative and would be a great educational tool. Can you please tell me how or where you found the above article? Did you have to pay for an extra subscription? thank you! Susan
 
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