Part B Insider (Multispecialty) Coding Alert

Published on Sun Apr 09, 2006 PDF

Find out when it's appropriate to add 80 or 82 modifiers to the mix

One code describes all aspects to an elective vasectomy; however, that's not the case for laparoscopic vasectomies. Here's how to choose the right code every time.

Problem: Medicare doesn't cover elective vasectomies at all. And although more private carriers are covering at least a portion of the cost, coders often don't know how to report the procedure to ensure payment.

Solution: You should report the vasectomy using CPT 55250 (Vasectomy, unilateral or bilateral [separate procedure], including postoperative semen examination[s]). The code includes the local or regional anesthesia that the urologist administers.

The urologist usually performs the procedure, which involves cutting the vas deferens and suturing the ends on both the left and right sides. Because the code descriptor specifies unilateral or bilateral, however, report the procedure the same way whether it's done on one or both sides.

Another option: You may also see "laparoscopic vasectomy" in your physician's documentation. This procedure often occurs when a patient requests a vasectomy at the same time he's undergoing a laparoscopic hernia repair, experts say. In this situation, the general surgeon and urologist will likely assist each other. All laparoscopic procedures allow for billing an assistant surgeon, so each physician may charge an assistance fee in addition to reporting his individual procedures.

Tip: Add modifiers 80 (Assistant surgeon) or 82 (Assistant surgeon [when qualified resident surgeon not available]) to the laparoscopic code.

Although Medicare doesn't reimburse for elective vasectomies, Medicaid does, with a few stipulations. The Medicaid-covered patient must be over 21 years of age, and he must sign a sterilization consent form. The urologist must wait at least 30 days after the patient signs the authorization form before performing the vasectomy.