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Sperm Cord Lipoma Unbundling from Inguinal Hernia Repair

Camille Posted Wed 05th of February, 2020 16:53:54 PM
In September 2000; Volume 10: Issue 9, CPT Assistant advised Lipoma Excision was billable with Inguinal Hernia repair. But, in your publication of 01/17/2008 you advise Sperm Cord Lipomas should not be unbundled from Inguinal Hernia coding. Did CPT Assistant rescind their advice between September 2000 and January 2008? Will you please clarify? I copied and pasted both articles below, so no need to read further if you're already aware of both publications. THANKS VERY MUCH! "CPT® Assistant September 2000; Volume 10: Issue 9 September 2000 page 10 Coding Consultation Male Genital System, Surgery, 55520, 49505 (Q&A) 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." "You Be the Coder: Is Lipoma Excision Separate With Hernia Repair? Published on Thu Jan 17, 2008 Print Friendly and PDF PDF Question: During an inguinal hernia repair (49505) with mesh, the surgeon performs an excision of a lipoma of the spermatic cord. Should I report an additional code for the excision? The pathology report shows the specimen is a "hernia sac," and final diagnosis is "fibroadipose tissue." Pennsylvania Subscriber Answer: Code 55520 (Excision of lesion of spermatic cord [separate procedure]) properly describes excisions of the type your surgeon performed. But 55520 is a designated "separate procedure" that occurs here with a related primary procedure, the hernia repair 49505 (Repair initial inguinal hernia, age 5 years or older; reducible). Therefore, correct coding dictates that you bundle the excision into the hernia repair. In short: You would report only the hernia repair, as usual, using 49505, with no additional code for the excision of the spermatic cord lipoma."
SuperCoder Answered Thu 06th of February, 2020 03:19:00 AM

Hi Camille,

 

Both articles are correct. It all depends on the submitted documentation along with the diagnoses billed

 

As per NCCI edits, CPT code 55520 is a column 2 code for 49505, but you may use a CCI-associated modifier (59) to override the edit under appropriate circumstances.

 

For article published on Thu Jan 17, 2008, along with repair of inguinal hernia, excision of hernia sac (pathology report shows the specimen removed from cord is "hernia sac) was also performed. Since the hernia sac was removed, its excision would be considered included in the inguinal hernia repair code. If provider had removed lesion of the spermatic cord (lipoma of cord) along with repair of inguinal hernia (both being distinct procedures), we could have billed both codes together (both being distinct procedures) appending 59 modifier with CPT code 55520.

 

Thanks!

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