AHA Coding Clinic® for HCPCS - 2024 Issue 3; Clarifications

Clarification: Spermatic cord lipoma excision with hernia repair

A patient with a right indirect inguinal hernia presented for surgical repair. After administration of general anesthesia, a transverse incision was made overlying the right inguinal canal which was taken down through the subcutaneous tissue. Scarpa’s fascia was opened, the external oblique was cleared, and the inguinal canal was opened. Attention was directed to the large indirect hernia where the sac was dissected away from the cord contents and opened; there was no incarcerated content. The hernia sac was ligated, transected, and submitted to pathology. A large spermatic cord lipoma was found, removed, and sent to pathology- within this there was an area of fat necrosis that was excised and sent to pathology. Mesh was placed surrounding the cord structures above, overlapping the internal ring, and secured. Following the repair, the cord structures and the ilioinguinal nerve were positioned anatomically and the fascia was closed. The remaining tissue layers were closed, and the patient was sent to recovery. Coding Clinic for HCPCS, Fourth Quarter 2023, Page 17, advised to assign CPT code 55520 for excision of a spermatic cord lipoma, in addition to a code for the hernia repair with rationale that it would be appropriate to report both since they were from separate body systems. In this case, the necrotic fat specimen on pathologic examination contained lymph nodes- which would be in a separate body system. Is the published advice to mean that any time excisions are performed in different body systems, through the same incision, each excision is reported separately? Based on Coding Clinic for HCPCS’ rationale, is the excision of the necrotic fat coded separately with CPT code 38531? ...

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