Urology Coding Alert

Involving the patient may help you avoid losing out

Recouping reimbursement for an elective vasectomy can be a challenge, but you'll stand a better chance of getting paid if you can show proper authorization for the procedure and pay close attention to individual carrier requirements.

The dilemma: 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. 1. Code CPT 55250 Covers Unilateral, Bilateral Procedures You should report the vasectomy using 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. 2. Watch for Occasional Laparoscopic Vasectomies Laparoscopic vasectomies are another option coders may see. These procedures occur most often when a patient requests a vasectomy at the same time he's undergoing a laparoscopic hernia repair, experts say. Since the general surgeon already has the ports and instrumentation in place for the hernia repair, the urologist can perform the vasectomy laparoscopically.

Note: In situations like this, 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 assistant fee in addition to reporting his individual procedures.

For the assistant charge, add modifiers 80 (Assistant surgeon) or 82 (Assistant surgeon [when qualified resident surgeon not available]) to the corresponding laparoscopic procedure. But remember that carriers' guidelines will vary, so be sure to check which carriers will reimburse.

There is no CPT Code for laparoscopic vasectomy. For this procedure, you should report 55559 (Unlisted laparoscopy procedure, spermatic cord). "Downgrade to a paper claim, and send a detailed operative report as well as a cover letter explaining the reason for your approach and the details of this technology," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York, Stony Brook. "I would compare or benchmark the laparoscopic vasectomy to 55550 (Laparoscopy, surgical, with ligation of spermatic veins for varicocele), with respect to the surgical work, technology, equipment used, and time involved. Remember to indicate in the cover letter this benchmark determination." 3. Pay Attention to Age, Time Requirements Although Medicare doesn't reimburse for elective vasectomies, Medicaid does, with [...]