How To Use CPT Code 54505

CPT 54505 describes the procedure of biopsy of the testis, specifically an incisional biopsy. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 54505?

CPT 54505 involves the removal of a tissue sample from one or both testicles through an open incision in the scrotum. The purpose of this procedure is to obtain a sample for further examination under a microscope.

2. Official Description

The official description of CPT code 54505 is: ‘Biopsy of testis, incisional (separate procedure).’ If the procedure is performed bilaterally, modifier 50 should be appended to the code. If combined with vasogram, seminal vesiculogram, or epididymogram, code 55300 should be used instead.

3. Procedure

1. The physician cleans the skin over the testes with an antiseptic liquid.
2. Under local anesthesia, a small incision is made through the skin.
3. A small piece of testicular tissue is obtained through the incision.
4. The tissue sample is sent to the laboratory for further examination.

4. Qualifying circumstances

A testicular biopsy is performed when there is a need to obtain a tissue sample from one or both testicles. This procedure is typically done to investigate infertility, testicular cancer, or other conditions affecting the testes. It is important to note that CPT 54505 should not be reported if performed along with a related procedure in the same anatomic area or through the same incision, orifice, or surgical approach. Modifier 59 should be appended if the procedure is performed with an unrelated procedure. Modifier 50 should be used if the procedure is performed bilaterally.

5. When to use CPT code 54505

CPT code 54505 should be used when a physician performs an incisional biopsy of the testis as a separate procedure. It should not be reported if performed along with a related procedure. If the procedure is performed bilaterally, modifier 50 should be appended to the code.

6. Documentation requirements

To support a claim for CPT 54505, the physician must document the following information:

• Reason for the biopsy and the medical necessity
• Details of the procedure, including the use of local anesthesia
• Location and size of the incision
• Number of testicles biopsied
• Any complications or additional procedures performed
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 54505, ensure that the procedure is performed as a separate procedure and not in conjunction with a related procedure. If performed bilaterally, modifier 50 should be appended to the code. If performed with an unrelated procedure, modifier 59 should be appended. It is important to follow the specific guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT 54505 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes an incisional biopsy of the testis to investigate infertility.
2. A physician performs a separate procedure of testicular biopsy to diagnose testicular cancer.
3. A patient with testicular pain undergoes an incisional biopsy of the testis to determine the cause of the pain.
4. A physician performs an incisional biopsy of both testicles to investigate a suspected genetic condition.
5. A patient with an undescended testicle undergoes an incisional biopsy to assess the health of the testis.
6. A separate procedure of testicular biopsy is performed on a patient with suspected testicular torsion.
7. A physician performs an incisional biopsy of the testis to evaluate a testicular mass.
8. A patient with testicular trauma undergoes an incisional biopsy to assess the extent of the injury.
9. A separate procedure of testicular biopsy is performed on a patient with testicular swelling and inflammation.
10. A physician performs an incisional biopsy of the testis to investigate a suspected infection.