How To Use CPT Code 55970

CPT 55970 describes the surgical procedures performed to convert male anatomy to female anatomy in intersex patients. This article will cover the description, official terminology, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 55970?

CPT 55970 can be used to describe the staged surgical procedures performed to transform male anatomy into female anatomy in intersex patients. These procedures involve the removal of the penis, reshaping of genital tissue to appear more female, and the construction of a vagina.

2. Official Description

The official description of CPT code 55970 is: ‘Intersex surgery; male to female.’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider dissects and removes the penis while preserving vital structures.
3. The scrotum is incised, the testes are removed, and the flap of skin is pulled back.
4. The region between the scrotum and the anus is dissected and opened.
5. The excess skin from the patient is used to line the opening and create a vagina.
6. The labia are fashioned using skin from the scrotum and surrounding area.
7. The urethra is shortened, and the urethral opening is moved to mimic that of a female.
8. A stent or obturator is placed into the constructed vagina to aid in healing.

4. Qualifying circumstances

CPT 55970 is performed on intersex patients who desire to transition from male to female anatomy. The surgery involves the removal of male genitalia and the reconstruction of female genitalia. It is important to note that coverage for gender reassignment surgery and the staged procedures considered components of CPT 55970 may vary by payer, so it is essential to check individual payer’s guidelines.

5. When to use CPT code 55970

CPT code 55970 should be used when performing the staged surgical procedures to convert male anatomy to female anatomy in intersex patients. It is important to review the specific documentation requirements and guidelines of each payer to ensure appropriate usage of this code.

6. Documentation requirements

To support a claim for CPT 55970, the provider must document the following information:

• Preoperative diagnosis and indication for surgery
• Details of the surgical procedure performed
• Any complications or unexpected findings during the surgery
• Postoperative care and follow-up plan
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 55970, it is important to follow the specific billing guidelines of each payer. Some payers may require additional documentation or prior authorization for coverage. It is also important to note that CPT 55970 may or may not be reported with other codes depending on the payer’s guidelines. It is recommended to review the payer’s policies and guidelines to ensure accurate billing.

8. Historical information

CPT 55970 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 with intersex condition undergoing male to female intersex surgery to align their physical appearance with their gender identity.
2. An intersex individual opting for male to female intersex surgery to achieve a more feminine genital appearance.
3. A patient with gender dysphoria undergoing male to female intersex surgery as part of their gender transition process.
4. An intersex patient seeking male to female intersex surgery to improve their overall well-being and quality of life.
5. A transgender individual with an intersex condition choosing male to female intersex surgery to align their physical appearance with their gender identity.
6. An intersex patient undergoing male to female intersex surgery to address physical discomfort and improve their self-esteem.
7. A person with an intersex condition opting for male to female intersex surgery to enhance their body image and self-confidence.
8. An individual with gender incongruence undergoing male to female intersex surgery to alleviate gender dysphoria.
9. A patient with an intersex condition seeking male to female intersex surgery to achieve a more authentic expression of their gender identity.
10. An intersex individual choosing male to female intersex surgery to align their physical appearance with their internal sense of self.