Wiki Vasectomy 55250

[Theresa Johnson]

Does anyone know how to indicate that you are performing a vesectomy without the postoperative semen examination?

 

[vinayanmg]

I think we can append 52 modifier along with 55250 as to reduce the service.

 

[Melissa Harris CPC]

I believe you do not have to indicate if you are doing the pos-vas semen analysis when billing for the procedure. A post-vas semen analysis is usually done after the procedure (one month, or more). And these are global to the procedure. You would not have to indicate a reduced service because you are not performing the semen analsysis during the actual vasectomy.

Melissa Harris, CPC

 

[Theresa Johnson]

Hi Melissa and vinayanmg,

Thank you for responding to my question.

My next thought is that the analysis is part of the procedure (to be performed at a later date during the global period). So, if we were not going to order the analysis within the global, how would we indicate this? Modifier 52 would seem appropriate to me, but could result in a drastic underpayment for services rendered. The insurance would not necessarily know that the analysis was the part not performed. I am finding that the analysis is often being performed outside of the global due to the fact that the provider feels a more accurate result is obtained by waiting 4-5 months after the procedure. I am concerned about not reporting it correctly.