Urology Coder’s Flow Chart: Orchiopexy & Hernia Repair

Posted on 23. Feb, 2009 by Editor.

Let the surgical approach guide your code choices.

When your urologist performs an inguinal orchiopexy and a hernia repair in the same surgical session using another surgeon as an assistant and not a co-surgeon, you can report both procedures for the urologist.

Dr. Ferragamo + Mickey Mouse = Reimbursement Savvy & Family Fun.

Don’t let the code descriptor for 54640 (Orchiopexy, inguinal approach, with or without hernia repair) confuse you. When your urologist performs an inguinal orchiopexy and hernia repair in the same surgical session, you should report 54640 and one of the inguinal hernia repair codes (49495-49525) to ensure that you will be reimbursed for both procedures individually.

Bottom line: The Correct Coding Initiative (CCI) and CPT do not bundle 54640 with the inguinal hernia repair codes, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York, Stony Brook. Plus, both the AMA and the American Urological Association state that you can bill for both the orchiopexy procedure and the hernia repair if performed at the same time.

Bonus Flow Chart: Work you way through the following questions to determine which codes you should report based on your physician’s work.

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Mind Your Modifiers When Your Surgeon Works With Others

Posted on 16. Feb, 2009 by Editor.

Automatically appending modifier 52 could be costing you hundreds.

When your surgeon works with another physician during a procedure, you can face major coding challenges. If you don’t coordinate your coding with the other physician’s coder, both doctors could lose money and face audits.

Learn how to correctly code for these shared procedures with this real-world case study.

AUDIO CD: Two-fers! How to get paid for co-surgery and surgical assistance.

Review the Surgical Case

Scenario: A urologist and a general surgeon performed surgery on a patient. The urologist did the orchiopexy and performed the opening and closing. The general surgeon performed an inguinal hernia repair.

Coding dilemma: Which codes should each physician report, and what modifiers should the coders use,

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