How To Use CPT Code 54640

CPT 54640 describes the surgical procedure known as orchiopexy, which involves moving an undescended testicle into the scrotum using an inguinal or scrotal approach. This article will provide an overview of CPT code 54640, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of when to use this code.

1. What is CPT Code 54640?

CPT 54640 is used to describe the surgical procedure called orchiopexy, which is performed to move an undescended testicle into the scrotum. This procedure can be done using either an inguinal or scrotal approach, depending on the specific circumstances of the patient. It is important to note that if the orchiopexy is performed bilaterally, modifier 50 should be appended to the code.

2. Official Description

The official description of CPT code 54640 is: ‘Orchiopexy, inguinal or scrotal approach.’ It is worth mentioning that if the orchiopexy is performed in conjunction with an inguinal hernia repair, a different set of codes should be used (49495 – 49525).

3. Procedure

1. The surgeon begins by making a small incision in the inguinal area or scrotum, depending on the chosen approach.
2. Once the incision is made, the surgeon locates the undescended testicle(s) and carefully moves them into their proper position inside the scrotum.
3. If an inguinal approach is used, the surgeon mobilizes the spermatic cord to allow for the normal positioning of the testis within the scrotum.
4. If a scrotal approach is chosen, the surgeon creates a dartos pouch by making an incision in the high scrotal fold. Extra tissues are removed to accommodate the testicle(s) within the pouch.
5. The surgeon then anchors the testicle(s) to the tunica and scrotal wall using sutures, ensuring their stability and proper placement.
6. Finally, the incision(s) are closed using absorbable sutures.

4. Qualifying circumstances

CPT code 54640 is used for patients who have an undescended testicle(s) that requires surgical correction. This condition, known as cryptorchidism, is characterized by the failure of one or both testes to descend from the abdomen into the scrotum after birth. Orchiopexy is typically performed in male infants to correct cryptorchidism, but it can also be done in adults to treat testicular torsion.

5. When to use CPT code 54640

CPT code 54640 should be used when performing an orchiopexy using an inguinal or scrotal approach. It is important to note that this code should not be reported if the procedure involves an intra-abdominal testicle fixation via an open abdominal approach (use code 54650) or a laparoscopic approach (use code 54692). Additionally, exploration for an undescended testis should be reported using code 54560.

6. Documentation requirements

To support a claim for CPT code 54640, the surgeon must document the following information:

• Patient’s diagnosis of cryptorchidism or testicular torsion
• Details of the surgical approach used (inguinal or scrotal)
• Date of the procedure
• Incision site(s)
• Steps performed during the surgery, including mobilization of the spermatic cord (if applicable) and creation of a dartos pouch (if applicable)
• Any additional procedures performed in conjunction with the orchiopexy
• Any complications or unexpected findings
• Signature of the surgeon

7. Billing guidelines

When billing for CPT code 54640, it is important to ensure that the procedure was performed using either an inguinal or scrotal approach. Modifier 50 should be appended to the code if the orchiopexy is performed bilaterally. It is also worth noting that this code should not be reported if an inguinal hernia repair was performed in conjunction with the orchiopexy (use codes 49495 – 49525 for that scenario).

8. Historical information

CPT code 54640 was added to the Current Procedural Terminology system on January 1, 1990. The most recent historical change occurred on January 1, 2020, when the code description was updated to include the option of an inguinal approach with or without hernia repair.

9. Examples

1. A surgeon performs an orchiopexy using an inguinal approach to move an undescended testicle into the scrotum for a male infant with cryptorchidism.
2. Using a scrotal approach, a surgeon performs an orchiopexy to correct an undescended testicle in an adult male with testicular torsion.
3. During an orchiopexy procedure, a surgeon discovers an inguinal hernia and performs a hernia repair in conjunction with the orchiopexy.
4. A surgeon performs a bilateral orchiopexy using an inguinal approach for a male infant with bilateral cryptorchidism.
5. Using a scrotal approach, a surgeon performs an orchiopexy to move an undescended testicle into the scrotum for a male infant with unilateral cryptorchidism.
6. A surgeon performs an orchiopexy using an inguinal approach for an adult male with an undescended testicle due to testicular torsion.