Radical Orchiectomy (Testicular Cancer)

CPT 54530
Approach Open
Add-on / Variant CPTs
  • 54520 — Orchiectomy, simple
  • 54535 — Orchiectomy, radical, for tumor
Preoperative Diagnosis:

Right [left] testicular mass — [seminoma / non-seminomatous germ cell tumor] — suspicious on ultrasound, elevated [AFP / beta-hCG / LDH]

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] radical inguinal orchiectomy [with testicular prosthesis placement]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

General endotracheal [/ spinal]

Indications:

The patient is a [age]-year-old male with a right [left] testicular mass, [X] cm, on scrotal ultrasound with [hypoechoic / heterogeneous] characteristics. Tumor markers: AFP [X], beta-hCG [X], LDH [X]. CT abdomen/pelvis demonstrated [no retroperitoneal adenopathy / [X]-cm retroperitoneal adenopathy]. Radical orchiectomy via an inguinal approach was planned for diagnosis and treatment. The risks, benefits, and alternatives were discussed and informed consent was obtained.

Findings:

A [X]-cm [firm / heterogeneous] testicular mass was identified. The tunica vaginalis was opened — the mass was [confined to the testis / with [epididymal / cord] involvement]. The spermatic cord was ligated at the internal inguinal ring. The specimen was sent to pathology. Intraoperative frozen section was [not performed / performed — confirming [malignant germ cell tumor / benign]].

Description of Procedure:

The patient was positioned supine. The right [left] inguinal region was prepped and draped. A [5]-cm oblique inguinal incision was made in the right [left] inguinal crease. The external oblique aponeurosis was incised along its fibers. The spermatic cord was identified at the external inguinal ring and encircled with a Penrose drain.

The spermatic cord was mobilized proximally to the internal inguinal ring. A [curved clamp] was placed on the spermatic cord at the level of the internal inguinal ring. The testicle was delivered through the inguinal incision into the operative field. The gubernaculum was divided.

The tunica vaginalis was opened and the testicular mass was inspected. Intraoperative frozen section was [sent / not sent given obvious malignancy]. The spermatic cord was [doubly ligated and divided with [0-Silk] ties] at the internal inguinal ring. The testis and distal spermatic cord were excised and sent to pathology intact.

[Testicular prosthesis: A [medium / large] saline-filled silicone testicular prosthesis was inserted into the scrotum through the inguinal incision and secured to the dartos muscle with [3-0 Vicryl].]

The external oblique was closed with [2-0 Vicryl]. The ilioinguinal nerve was identified and preserved. Skin was closed with [3-0 Monocryl].

Complications:

None

Specimens:

Right [left] testis and spermatic cord — sent to pathology intact with [proximal cord margin marked with suture]

Estimated Blood Loss:

Minimal

Drains:

None

Disposition:

The patient was taken to the PACU in stable condition. Scrotal support was applied. Pathology results were to be correlated with serum tumor markers at [5–7 days] post-operatively to guide clinical staging and adjuvant therapy.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Right/Left testicular mass — *** suspicious for GCT
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left radical inguinal orchiectomy [+ prosthesis]
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General/spinal

INDICATIONS: .PTAGE-year-old male with *** cm testicular mass, ***. AFP ***, hCG ***, LDH ***. CT: ***. Consent obtained.

FINDINGS: *** cm mass, firm, ***. Tunica opened: ***. Cord to internal ring. Frozen: ***.

PROCEDURE:
Supine. Inguinal incision *** cm. External oblique incised. Cord identified at external ring, mobilized to internal ring. Testicle delivered through wound. Gubernaculum divided. Tunica opened, mass inspected. [Frozen: ***.] Cord doubly ligated and divided at internal ring with 0-Silk. Specimen excised intact. [Prosthesis *** placed, secured to dartos.] External oblique 2-0 Vicryl. Ilioinguinal nerve preserved. Skin closed.

EBL: Minimal
SPECIMENS: Testis + cord to pathology intact, cord margin marked
COMPLICATIONS: None
DISPOSITION: PACU. Scrotal support. Pathology + markers at 5–7 days.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Bilateral Orchiectomy (Prostate Cancer Hormonal Therapy)

For androgen deprivation in metastatic prostate cancer, bilateral simple orchiectomy was performed. Subcapsular orchiectomy was performed bilaterally — the tunica albuginea was incised and the seminiferous tubule contents were evacuated, leaving the tunica and epididymis intact (sub-capsular technique minimizes scrotal deformity). Bilateral simple orchiectomy provides immediate castrate testosterone levels (<50 ng/dL) equivalent to LHRH agonist therapy, with no ongoing drug cost or depot injection requirement.

Charting Tips
  • Document inguinal (not scrotal) approach. Transcrotal orchiectomy alters lymphatic drainage from paraaortic to inguinal nodes, potentially upstaging the patient and altering surveillance/treatment. Document 'radical inguinal orchiectomy' explicitly. If scrotal violation occurred (prior scrotal biopsy/surgery), document this and note that groin surveillance may be needed.
  • Document proximal cord margin. The spermatic cord should be ligated at the level of the internal inguinal ring to obtain a negative cord margin. Document 'cord ligated at the internal inguinal ring' and that the margin was sent to pathology.
  • Document frozen section decision. Frozen section is not universally performed for obvious malignancy by ultrasound and tumor markers. If the diagnosis is uncertain (normal markers, negative imaging, small hypoechoic lesion), frozen section guides whether the testis is removed. Document the decision.
Billing Tips
  • 54530 (radical inguinal orchiectomy for tumor, 8.25 wRVU) is the standard code for testicular cancer. It covers the inguinal approach with en-bloc removal of the testis and spermatic cord.
  • 54520 (simple orchiectomy, 5.17 wRVU) is for simple scrotal orchiectomy (e.g., trauma, torsion with nonviable testis, hormonal suppression). It is not appropriate for oncologic resection.
  • 54535 (extensive surgery for large tumor with retroperitoneal lymph node dissection, 12.86 wRVU): use only when RPLND is performed at the same session as orchiectomy.
  • Bilateral simple orchiectomy for hormonal suppression (prostate cancer): bill 54520-50 for bilateral or 54522 (bilateral, specific code if available). Verify bilateral modifier rules with payer.
  • Testicular prosthesis insertion at the same session (54660) is separately billable. Document patient request and consent; some payers require prior authorization.
  • Global period is 90 days. Post-op wound care and standard follow-up are bundled. Tumor marker surveillance (β-hCG, AFP, LDH) ordered post-op is not included in the surgical global.
  • For scrotal approach in benign disease, use 54520 and document the indication clearly, as payers may question scrotal orchiectomy for oncologic indications (should be inguinal).