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.
Download ReportTranscript 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.
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 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 Case #4 71.4 % 54640 75 59% 49500 31.4 % 64425 33 29.5% 54650 27.6% 54512 49010 4 54550 1 0 62 31 29 3.8% 1% 10 20 30 40 50 60 70 80 54 65 0 54 54 64 65 0 0 4 54 54 6 95 0 40 0 65 0 4 54 495 95 0 0 64 00 0 54 4 9 51 54 5 00 2 64 0 5 4 49 5 0 5 12 0 54 490 65 10 0 54 545 64 12 0 5 54 54 6 45 1 2 50 64 0 54 490 65 10 0 54 5 5 4 54 64 650 12 0 49 546 01 40 0 54 51 2 number of respondents Case #4 Responses 35 10 5 30 30 25 25 20 15 13 6 12 5 6 2 2 procedure codes billed 1 1 1 0 1 Experts Choice 1 1 1 1 54640 49010 54512 24.62 54650 54640 54650 49010 2 54640 54512 2 54650 54512 40.67 40.23 33.92 31.37 54640 54650 54512 procedure codes billed 54640 49500 49010 27.30 30 25 18.00 20.55 11.25 13 6 54640 49500 54512 54650 49500 54512 54640 49500 54650 49500 45 40 35 30 25 20 15 10 5 0 54640 54650 number of respondents Case #4 37.68 12 44.30 24.62 18.00 5 6 rvu S1 Case #4 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 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. 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 Case #5: 91.7% 49505 70.6% 49320 32.1 % 64425 26.6 % 54512 20.1 55040 0 100 77 35 29 22 20 40 60 80 100 120 Case # 5 Responses 34 35 number of repsonses 30 25 20 20 15 13 10 7 5 7 4 3 6 5 2 1 2 1 2 1 0 49505 49505 64425 49505 49320 49505 49320 64425 49505 49320 64425 54512 49505 49320 54512 49505 49320 55040 49505 49320 55040 64425 49505 49320 55040 54512 procedures 49505 49320 55040 54512 64425 49505 54512 55040 55040 49320 55040 49320 64425 55040 64425 55040 54512 49650 29.43 procedures 4 5 2 1 2 1 2 55040 54512 49650 14.79 55040 64425 12.37 55040 49320 64425 0 42.8 45.22 55040 49320 3 49505 54512 55040 7 34.12 49505 49320 55040 54512 64425 10 49505 49320 55040 54512 30 49505 49320 55040 64425 5 36.54 49505 49320 55040 34 49505 49320 54512 15 20 49505 49320 64425 54512 25 49505 49320 64425 35 49505 49320 20 49505 64425 49505 number of repsonses Case #5 Case #5 31.85 34.42 32.44 20.75 23.17 17.06 19.48 13 7 11.1 6 reponses RVU 1 reponses Experts choice Case #5 Would you be interested in making these coding panel sessions a regular part of the AAP meetings in the future? 11 7 Yes No Indifferent 90 Would you like to have a similar questionnaire format before each session in which specific coding issues can be addressed in the coding panels? 10 4 Yes No Indifferent 94 Case #4 Case #5