How To Use CPT Code 55520

CPT 55520 describes the excision of a lesion in the spermatic cord, which is a separate procedure. 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 55520?

CPT 55520 is used to describe the surgical removal of diseased or damaged tissue from the spermatic cord in the scrotum. This procedure is performed to alleviate pain or discomfort and restore fertility. The provider makes an incision in the scrotum, removes the lesion by dissecting it from surrounding tissues, and repairs the area with sutures. The nerves and vessels of the testis are carefully preserved during the procedure.

2. Official Description

The official description of CPT code 55520 is: ‘Excision of lesion of spermatic cord (separate procedure).’ This code represents the surgical removal of a lesion specifically from the spermatic cord.

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. An incision is made in the scrotum.
3. The provider removes the lesion by dissecting it from all adjacent connections.
4. The surrounding tissues are repaired with sutures.
5. The nerves and vessels of the testis are preserved.
6. A drain may be placed, and the incision in the scrotum is closed with sutures in layers.

4. Qualifying circumstances

CPT 55520 is performed on patients who have a lesion in the spermatic cord that requires surgical excision. The procedure is indicated to relieve pain or discomfort and restore fertility. It is important to note that this code should not be reported if performed along with a related procedure in the same anatomic area or through the same incision or surgical approach. If the procedure is performed with an unrelated procedure, modifier 59 should be appended to the code to indicate a distinct procedural service. Additionally, CPT 55520 represents a unilateral service, meaning it is performed on one side of the spermatic cord. If the procedure is performed bilaterally, modifier 50, Bilateral procedure, or modifiers RT and LT should be applied based on payer preference.

5. When to use CPT code 55520

CPT code 55520 should be used when a provider performs the excision of a lesion in the spermatic cord as a separate procedure. It should not be reported when performed along with a related procedure in the same anatomic area or through the same incision or surgical approach. Modifier 59 should be appended if the procedure is performed with an unrelated procedure.

6. Documentation requirements

To support a claim for CPT 55520, the provider must document the following information:

• Patient’s diagnosis necessitating the excision of the lesion
• Description of the lesion and its location in the spermatic cord
• Date of the procedure
• Details of the surgical technique used
• Any additional procedures performed during the same encounter
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 55520, ensure that the procedure is performed as a separate procedure and not in conjunction with a related procedure in the same anatomic area or through the same incision or surgical approach. If the procedure is performed with an unrelated procedure, modifier 59 should be appended to indicate a distinct procedural service. It is important to note that CPT code 55520 represents a unilateral service, so modifiers 50, RT, or LT should be applied if the procedure is performed bilaterally.

8. Historical information

CPT 55520 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 patient undergoes excision of a lesion in the spermatic cord to alleviate chronic pain.
2. A provider performs the surgical removal of a lesion in the spermatic cord to restore fertility in a patient.
3. A lesion in the spermatic cord is excised to relieve discomfort and improve the patient’s quality of life.
4. A provider performs the excision of a lesion in the spermatic cord as a separate procedure during the same encounter as an unrelated procedure.
5. A patient undergoes excision of a lesion in the spermatic cord on one side, with modifier 50 applied to indicate a bilateral procedure.