How To Use CPT Code 55559

CPT 55559 describes a laparoscopy procedure on the spermatic cord that does not have a specific code. 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 55559?

CPT 55559 is used to report laparoscopy procedures on the spermatic cord that do not have a specific code. This code is used when a provider performs a laparoscopy procedure on the spermatic cord that is not represented by any of the standard and active CPT codes available.

2. Official Description

The official description of CPT code 55559 is: ‘Unlisted laparoscopy procedure, spermatic cord.’

3. Procedure

1. A laparoscopy procedure on the spermatic cord is performed by a provider.
2. The provider makes several incisions in the abdomen and inflates it with carbon dioxide for better exposure.
3. A scope is inserted through one of the incisions to examine the abdomen, while other incisions are used for inserting instruments.
4. Ports are placed to keep the incisions open and are removed at the conclusion of the procedure.
5. The small incisions are closed with staples or sutures.

4. Qualifying circumstances

CPT 55559 is used when there is no specific code available to accurately describe the laparoscopy procedure performed on the spermatic cord. It is important to note that CPT guidelines instruct not to choose a code that merely approximates the service provided. Instead, the unlisted procedure code should be used when no specific procedure or service code exists.

5. When to use CPT code 55559

CPT code 55559 should be used when a provider performs a laparoscopy procedure on the spermatic cord that does not have a specific code. It is important to ensure that there is no other specific code available before reporting an unlisted procedure code.

6. Documentation requirements

To support a claim for CPT 55559, it is crucial to provide a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. The cover letter should include one or more similar codes and compare the service to those codes to justify the claim amount being billed. Additionally, operative notes or other relevant documentation should be included to strengthen the claim and avoid a possible denial.

7. Billing guidelines

When reporting CPT 55559, it is important to submit a cover letter explaining the reason for using the unlisted code. The cover letter should include similar codes and compare the service to those codes to justify the claim amount. Payers will consider claims with unlisted procedure codes on a case-by-case basis and determine payment based on the documentation provided.

8. Historical information

CPT 55559 was added to the Current Procedural Terminology system on January 1, 2000. There have been no updates to the code since its addition.

9. Examples

1. A provider performs a laparoscopy procedure on the spermatic cord to remove a cyst.
2. A laparoscopy procedure on the spermatic cord is performed to repair a hernia.
3. A provider uses laparoscopy to diagnose and treat a condition affecting the spermatic cord.
4. A laparoscopy procedure on the spermatic cord is performed to remove scar tissue.
5. A provider performs a laparoscopy procedure on the spermatic cord to address chronic pain.
6. A laparoscopy procedure on the spermatic cord is performed to investigate the cause of infertility.
7. A provider uses laparoscopy to remove a tumor from the spermatic cord.
8. A laparoscopy procedure on the spermatic cord is performed to address varicocele.
9. A provider performs a laparoscopy procedure on the spermatic cord to treat testicular torsion.
10. A laparoscopy procedure on the spermatic cord is performed to address a hydrocele.