Primary Care Coding Alert

Question: A patient comes in with his wife for a vasectomy consultation with our physician. They review the procedure, sign the necessary releases and discuss pre-op instructions. Is this included in the global package?

Ohio Subscriber

Answer: If the patients are covered by commercial insurers that follow CPT guidelines, you have been missing a legitimate opportunity to bill for this office visit. CPT rules say that the vasectomy surgery itself (55250, vasectomy, unilateral or bilateral [separate procedure], including postoperative semen examination[s]) and normal, uncomplicated aftercare are included with the global package. Preoperative care is not included.

Medicare, on the other hand, includes one day of preoperative care on services that carry a 90-day global surgical period, which 55250 does. However, Medicare will pay for an E/M service on the day of, or on the day before, a procedure with a 90-day global surgical period if the physician uses CPT modifier -57 (decision for surgery) to indicate that the service was for the decision to perform the procedure (Medicare Carriers Manual section 15501.1.C). Medicare will not pay for an E/M service billed with modifier -57 if it was provided on or the day before a procedure with a 0- or 10-day global surgical period.