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Case #4

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. Case #4.

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Case #4

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  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. 71.4 % 59% 31.4 % 29.5% 27.6% 3.8% 1 % 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 don’t 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

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