How To Use CPT Code 54550

CPT 54550 describes the exploration of the inguinal or scrotal area to locate an undescended testis or identify an absent testis. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 54550?

CPT 54550 involves the exploration of the inguinal or scrotal area to identify the location of an undescended testis or to determine if a testis is absent. This code is used when a provider makes an incision in the scrotum or lower abdomen, dissects through the tissue, and explores the groin and scrotal area to locate the testicle.

2. Official Description

The official description of CPT code 54550 is: ‘Exploration for undescended testis (inguinal or scrotal area).’ This code may be reported with modifier 50 for a bilateral procedure.

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the scrotum or lower abdomen.
3. The provider dissects down through the tissue to access the inguinal or scrotal area.
4. The provider explores the groin and scrotal area to locate the undescended testis.
5. If the testis is located, the provider may perform a separate procedure to unveil and free the testis, lower it into the scrotal sac, and secure it with stitches.
6. If both testicles are undescended, the provider repeats the exploration and separate procedure for the other testicle.

4. Qualifying circumstances

CPT 54550 is performed when there is a need to locate an undescended testis or identify an absent testis. It is typically performed on patients with cryptorchidism, which is the absence of one or both testes from the scrotum. The procedure is carried out by a provider who explores the inguinal or scrotal area to locate the testis.

5. When to use CPT code 54550

CPT code 54550 should be used when a provider performs an exploration of the inguinal or scrotal area to locate an undescended testis or identify an absent testis. It should not be used for other procedures or conditions unrelated to the exploration of the testis.

6. Documentation requirements

To support a claim for CPT 54550, the provider must document the following information:

• Reason for the exploration (e.g., undescended testis, absent testis)
• Location of the incision (scrotum or lower abdomen)
• Details of the exploration procedure
• Findings (e.g., location of the testis, presence or absence of the testis)
• Any additional procedures performed (e.g., unveiling and freeing the testis, securing it with stitches)
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 54550, ensure that the exploration is performed in the inguinal or scrotal area to locate an undescended testis or identify an absent testis. Use modifier 50 if the procedure is performed bilaterally. It is important to note that CPT 54550 should not be reported with other codes unless specific circumstances apply. For example, if an inguinal or abdominal exploration fails to reveal a testicle, use CPT 54550 to report the surgical exploration. If the exploration constitutes the major procedure and a small atrophic testicle is discovered and removed, report CPT 54560 with modifier 51 appended.

8. Historical information

CPT 54550 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A provider performs an exploration of the inguinal area to locate an undescended testis in a pediatric patient.
2. A surgeon makes an incision in the scrotum and explores the scrotal area to identify an absent testis in an adult patient.
3. A urologist dissects through the tissue in the lower abdomen to access the inguinal area and locate an undescended testis in a teenage patient.
4. A pediatric surgeon performs an exploration of the scrotal area to unveil and free an undescended testis in an infant.
5. An urologist repeats the exploration and separate procedure for the other undescended testis in a young child.
6. A provider explores the inguinal area to identify an absent testis in a patient with cryptorchidism.
7. A surgeon performs an exploration of the scrotal area to locate an undescended testis in a male adolescent.
8. An urologist dissects through the tissue in the lower abdomen to access the inguinal area and identify an absent testis in an adult patient.
9. A pediatric surgeon performs an exploration of the scrotal area to unveil and free an undescended testis in a newborn.
10. An urologist repeats the exploration and separate procedure for the other undescended testis in a pre-teen patient.