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The procedure described by CPT® Code 56805 refers to clitoroplasty performed for individuals with an intersex state. An intersex state is a medical condition characterized by the presence of both male and female anatomical features, which complicates the determination of gender based solely on external genitalia. This condition encompasses various forms, including true hermaphroditism and both female and male pseudohermaphroditism. True hermaphrodites possess both ovarian and testicular tissue, resulting in mixed male and female sex organs. In contrast, a female pseudohermaphrodite is genetically female but has external genitalia that resemble male structures, such as a penis. Conversely, a male pseudohermaphrodite is genetically male but exhibits underdeveloped external genitalia. Clitoroplasty is a surgical intervention typically indicated for true hermaphrodites who identify as female or for female pseudohermaphrodites. The procedure involves reconstructive surgery aimed at modifying the external genitalia, specifically reducing the size of an enlarged clitoris or a small penis to create a more typical appearance of a clitoris. During this surgical process, the physician prioritizes the preservation of neurovascular function to maintain sensitivity and overall sexual health.
© Copyright 2025 Coding Ahead. All rights reserved.
The clitoroplasty procedure, as described by CPT® Code 56805, is indicated for specific conditions associated with intersex states. The following are the primary indications for performing this surgical intervention:
The clitoroplasty procedure involves several critical steps to ensure effective surgical outcomes. The following outlines the procedural steps involved:
After the clitoroplasty procedure, patients typically require careful monitoring and follow-up care. Postoperative care includes managing pain, monitoring for any signs of infection, and ensuring proper healing of the surgical site. Patients may be advised on activity restrictions to promote recovery and prevent complications. Follow-up appointments are essential to assess the surgical outcomes, address any concerns, and provide additional support as needed. The preservation of neurovascular function is closely monitored to ensure that the patient retains sensitivity and overall sexual health following the procedure.
| Short Descr | CLITOROPLASTY INTERSEX STATE | Medium Descr | CLITOROPLASTY INTERSEX STATE | Long Descr | Clitoroplasty for intersex state | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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 | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 132 - Other OR therapeutic procedures, female organs |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | CR | Catastrophe/disaster related | 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 |
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| 2025-01-01 | Changed | Short Description changed. |
| 2011-01-01 | Changed | Medium description changed. |
| 1992-01-01 | Added | First appearance in code book in 1992. |
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