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Epididymectomy is a surgical procedure that involves the removal of the epididymis, which is a coiled tube located at the back of each testis responsible for storing and maturing sperm. This procedure is typically performed under general or regional anesthesia with the patient positioned supine, meaning lying on their back. The surgical area, including the penis and scrotum, is thoroughly prepared and draped to maintain a sterile environment. A transverse incision is made in the skin of the hemiscrotum, allowing access to the underlying structures. The surgeon employs both sharp and blunt dissection techniques to carefully separate the testis, epididymis, and vas deferens from surrounding tissues, ensuring that these structures are freed and brought into the operative field for further manipulation. If the patient has previously undergone a vasectomy, the dissection will continue above the vasectomy site to ensure complete removal of the epididymis. In cases where no prior vasectomy has been performed, the vas deferens may be divided and ligated at the junction of the convoluted and straight sections. The procedure continues with dissection towards the vaso-epididymal junction, where the epididymis is detached from the testis, and any encountered blood vessels, such as the epididymal artery, are ligated. The removal of the entire specimen is performed with care to ensure that the surgical site is clean and free of bleeding, which is controlled using electrocautery or absorbable sutures. Finally, the testis is returned to the scrotal sac, and the surgical site is closed in layers to promote proper healing. This procedure is indicated for various conditions affecting the epididymis, including infections, cysts, or tumors, and is coded as CPT® 54861 when performed bilaterally.
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The procedure of bilateral epididymectomy is indicated for several specific conditions affecting the epididymis. These include:
The bilateral epididymectomy procedure involves several critical steps to ensure successful removal of the epididymis while preserving surrounding structures. The process begins with the patient positioned supine, and the surgical area is prepared and draped to maintain sterility. A transverse incision is made in the skin of the hemiscrotum, which is then extended down to the tunica vaginalis, the protective layer surrounding the testis. The surgeon employs both sharp and blunt dissection techniques to create a plane between the tunica vaginalis and the dartos fascia, allowing for the careful mobilization of the testis, epididymis, and vas deferens into the operative field. If the patient has a history of vasectomy, the dissection continues above the vasectomy site to ensure complete access to the epididymis. In cases without prior vasectomy, the vas deferens is divided and ligated using absorbable suture at the junction of the convoluted and straight sections. The dissection then proceeds towards the vaso-epididymal junction, where the surgeon meticulously separates the epididymis from the testis, ligating the epididymal artery if encountered during the process. Upon reaching the testicular efferent ducts, these structures are ligated with absorbable suture or cauterized to prevent bleeding. The entire specimen, consisting of the epididymis, is then removed intact. After the removal, the surgical site is irrigated, and any bleeding in the epididymal bed is controlled using electrocautery or fine absorbable sutures. Finally, the testis is returned to the scrotal sac, and the edges of the tunica vaginalis are closed, followed by a layered closure of the dartos fascia and skin to ensure proper healing.
Post-procedure care following a bilateral epididymectomy includes monitoring for any signs of complications such as infection, bleeding, or excessive swelling. Patients are typically advised to rest and avoid strenuous activities for a specified period to promote healing. Pain management may be necessary, and the use of ice packs can help reduce swelling. Follow-up appointments are essential to assess the surgical site and ensure proper recovery. Patients should be instructed to report any unusual symptoms, such as fever or increased pain, to their healthcare provider promptly. Overall, the expected recovery time may vary, but most patients can return to normal activities within a few weeks, depending on individual healing and any underlying conditions.
| Short Descr | REMOVAL OF EPIDIDYMIS | Medium Descr | EPIDIDYMECTOMY BILATERAL | Long Descr | Epididymectomy; bilateral | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 118 - Other OR therapeutic procedures, male genital |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | KX | Requirements specified in the medical policy have been met | RT | Right side (used to identify procedures performed on the right side of the body) |
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