Urology Coding Alert

Question: One of our doctors would like to start doing sperm aspiration on patients who have previously had vasectomies in order to have the patient's wife use the sperm in artificial insemination. He's considering using microsurgical epididymal sperm aspiration (MESA), percutaneous testicular sperm aspiration (TESA) and percutaneous epididymal sperm aspiration (PESA) procedures. Which codes should we use for these procedures? We figure that most -- if not all -- insurance companies will deny this and that it will be the responsibility of the patient to pay for the procedure.

New York Subscriber

Answer: The best code for MESA, TESA and PESA is an unlisted-procedure code. But your suspicion is correct -- typically these are not covered. You should verify the patient's benefits up front and make payment arrangements before you start the procedure. When the payer does allow this under the subscriber's benefits, submit documentation with the claim up front.

Warning: You may be tempted to consider 10021 (Fine needle aspiration; without imaging guidance) or 10022 (... with imaging guidance), but many infertility specialists do not think they are appropriate.