Case

1
Case 4
1 year old with high testis at level of internal
ring. Procedure performed Difficult orchidopexy
requiring extensive retroperitoneal dissection
(vessels preserved), hernia repair, excision of
the appendix testis, and inguinal nerve block.
2
Case 4

• 54640 - Orchiopexy, inguinal approach, with or
  without hernia repair
• 54650 - Orchiopexy, abdominal approach for
  intraabdominal testis
• 49500 - Repair initial inguinal hernia, age 6 mos
  -5 years reducible
• 49010 - Exploration, retroperitoneal area with or
  without biopsy(s) (separate procedure)
• 54550 - Exploration for undescended testis
  (inguinal or scrotal area)
• 54512 - Excision of extraparenchymal lesion of
  testis
• 64425 - Injection, anesthetic agent
  ilioinguinal, iliohypogastric nerves

3
Case 4
4
Case 4 Responses
5
Case 4
Experts Choice
6
Case 4
7
Advice from a billing expert

• Medicare rules are consistent while private
  insurer rules vary
• Bill Fee for service until proven that they dont
  pay
• Editor of the Urology coding alert

8
Case 5
6 year old boy presents with a reducible
communicating hydrocele. Procedure performed At
exploration a hernia sac is tied off and excised.
The tunica vaginalis is opened and excised as
well as the appendix testis. Diagnostic
laparoscopy is performed via the hernia sac and
the contralateral side is inspected and found to
be closed. An ilioinguinal nerve block is
performed with marcaine at the end of the
procedure.
9
Case 5

• 49505 - Repair initial inguinal hernia, age 5
  years or over reducible
• 55040 - Scrotal hydrocelectomy
• 49320 - Laparoscopy, abdomen, peritoneum, and
  omentum, diagnostic, with or without collection
  of specimen(s) by brushing or washing (separate
  procedure)
• 54512 - Excision of extraparenchymal lesion of
  testis
• 64425 - Injection, anesthetic agent
  ilioinguinal, iliohypogastric nerves
• 49650-51 - Laparoscopy, surgical repair initial
  inguinal hernia
• 55060 - Repair of tunica vaginalis hydrocele
  (Bottle type)
• 55500 - Excision of hydrocele of spermatic cord,
  unilateral (separate procedure

10
Case 5
91.7
70.6
32.1
26.6
20.1
11
Case 5 Responses
12
Case 5
Experts choice
13
Case 5
14
Would you be interested in making these coding
panel sessions a regular part of the AAP meetings
in the future?
15
Would you like to have a similar questionnaire
format before each session in which specific
coding issues can be addressed in the coding
panels?
16
Case 4
17
Case 5