Urology Coding Alert

Question: How should I code a vas reversal after a laparoscopic vasectomy for sterilization? The patient had a previous hernia repair with sterilization. The urologist approached the reversal through the old hernia site after a general surgeon gained access.


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Answer: Code 55400 (Vasovasostomy, vasovasorrhaphy) does not specify a particular surgical approach, although a trans-scrotal approach is most common. Because the urologist performed the initial vasectomy through a laparoscopic approach, the surgical approach for the vasovasostomy is through a retroperitoneal incision and approach.

For gaining the access, the general surgeon should report 49010 (Exploration, retroperitoneal area with or without biopsy[s] [separate procedure]). For your urologist, report 55400 for the vasovasostomy. These two codes most accurately describe what the doctors did, since there is no single code to completely explain the nature of this procedure.

Adding modifiers such as -22 (Unusual procedural services) or -52 (Reduced services) would only hold up payment and complicate the coding explanation of what was really done. Use diagnosis V26.0 (Tuboplasty or vasoplasty after previous sterilization).