How To Use CPT Code 54560

CPT 54560 describes the exploration for an undescended testis, including exploration into the abdomen. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 54560?

CPT 54560 can be used to describe the exploration for an undescended testis, which involves searching for the location of a testicle that has not descended into the scrotum. This procedure may also be performed to identify an absent testis. It is important to note that this code is specifically for exploration and does not include fixation or orchiopexy procedures.

2. Official Description

The official description of CPT code 54560 is: ‘Exploration for undescended testis with abdominal exploration.’

3. Procedure

1. The provider begins by making an incision in the inguinal area, which is the area between the abdomen and the upper thigh.
2. The incision is extended into the abdomen to allow for exploration of the groin and lower abdomen.
3. The provider carefully searches for the undescended testicle, using visual and tactile examination.
4. If the testicle is located, the provider may perform a separate procedure to unveil and free the testicle.
5. The testicle is then lowered into the scrotal sac and secured with stitches.
6. If both testicles are undescended, the provider repeats the exploration and separate procedure for the other testicle.

4. Qualifying circumstances

CPT 54560 is typically performed on patients with cryptorchidism, which is the absence of one or both testes from the scrotum. This condition is the most common birth defect of the male genitalia. The procedure is performed by a provider to identify the location of the undescended testicle or to confirm the absence of a testis. It is important to note that if the procedure is performed bilaterally, modifier 50 should be appended to the code.

5. When to use CPT code 54560

CPT code 54560 should be used when the provider performs an exploration for an undescended testis, including exploration into the abdomen. It is important to note that this code is specifically for exploration and does not include fixation or orchiopexy procedures. If fixation of an intra-abdominal testicle is performed via an open abdominal approach, CPT code 54650 should be used. For orchiopexy of an intra-abdominal testis using a laparoscopic approach, CPT code 54692 should be used. If orchiopexy is performed via a scrotal approach, CPT code 54640 is appropriate.

6. Documentation requirements

To support a claim for CPT code 54560, the provider must document the following information:

• Patient’s diagnosis of cryptorchidism or suspicion of an absent testis
• Details of the exploration procedure, including the incision site and extent of exploration
• Location of the undescended testicle, if found
• Any additional procedures performed, such as unveiling and freeing the testicle
• Confirmation of the testicle being lowered into the scrotal sac and secured with stitches
• Use of modifier 50 if the procedure is performed bilaterally

7. Billing guidelines

When billing for CPT code 54560, ensure that the procedure performed is specifically for exploration of an undescended testis, including exploration into the abdomen. This code should not be reported with codes 54650, 54692, or 54640, as those codes represent different procedures. It is important to follow the guidelines provided by the payer and use appropriate modifiers if necessary.

8. Historical information

CPT code 54560 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 for an undescended testis in a 6-year-old patient with suspected cryptorchidism.
2. During a routine physical examination, a provider identifies an absent testis in a 16-year-old patient and performs an exploration to confirm the absence.
3. A 2-year-old patient is diagnosed with cryptorchidism, and a provider performs an exploration to locate the undescended testicle.
4. A provider performs an exploration for an undescended testis in a 10-year-old patient with suspected cryptorchidism.
5. During a surgical procedure for another condition, a provider performs an exploration for an undescended testis and successfully locates and lowers the testicle into the scrotal sac.
6. A provider performs an exploration for an undescended testis in a 4-year-old patient with suspected cryptorchidism.
7. During a routine physical examination, a provider identifies an absent testis in a 12-year-old patient and performs an exploration to confirm the absence.
8. A 3-year-old patient is diagnosed with cryptorchidism, and a provider performs an exploration to locate the undescended testicle.
9. A provider performs an exploration for an undescended testis in an 8-year-old patient with suspected cryptorchidism.
10. During a surgical procedure for another condition, a provider performs an exploration for an undescended testis and successfully locates and lowers the testicle into the scrotal sac.