Capture Orchiopexy and Hernia Repair Pay With This Chart

Urology Coding Alert

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.

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. Don't let the code descriptor for 54640 (Orchiopexy, inguinal approach, with or without hernia repair) confuse you.

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 American Medical Association 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: Work you way through the following questions to determine which codes you should report based on your physician's work.