Understand if Modifier 52 Is Needed for a Unilateral Vasectomy
Question: A patient who had a testicle removed five years prior due to cancer presented for a vasectomy. Since the patient had only one testicle, the urologist performed the procedure on one side of the body. Would I report 55250-52 to report the procedure? Ohio Subscriber Answer: No, you won’t append modifier 52 (Reduced services) to 55250 (Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)) to report the procedure. Instead, you’ll just report 55250. When you review the descriptor for 55250, you’ll notice that the procedure code covers both unilateral and bilateral vasectomies. This means that you’ll report the code regardless of whether the urologist operates on one side or both sides of the patient’s body. Additionally, you won’t separately report the anesthesia for the procedure since it’s included in the surgical procedure. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
