Orchiopexy with hernia repair 54640 + 49505

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Orchiopexy with hernia repair 54640 + 49505

Postby maryv22 » Wed Aug 08, 2018 1:09 pm

Good Morning,

There has been confusion whether or not codes 54640 and 49505 can be billed together. CPT guidelines are misleading.

54640 in CPT—by definition, “Orchiopexy, inguinal approach, with or without hernia repair.” Yet, in parentheses, it states, “For inguinal hernia repair performed in conjunction with inguinal orchiopexy, see 49495-49525.”

Based on the above excerpt from CPT GL, I believe it is ok to bill both 54640 and 49505. Can you let me know your thoughts? Any feedback is much appreciated!

Thanks,
Mary
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Re: Orchiopexy with hernia repair 54640 + 49505

Postby admin » Mon Aug 20, 2018 1:22 pm

Hello,

There are no current NCCI bundling edits between the two codes. As a point of clarification, the orchiopexy description stating “with or without hernia repair” is basically saying sometimes the patient will require a hernia repair in addition to the orchiopexy, and sometimes the patient will not.

Taken this into account, along with the specific CPT instruction to add a hernia repair code if needed, as well as the current edits, a patient presenting for orchiopexy who also requires a hernia repair would get both codes.

Your question has been answered by J. Paul Spencer, CPC, COC
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