# Vasectomy help please



## tammyross

New to urology and need a little help with the difference between 55250, Vasectomy and 55450 Ligation (percutaneous) of vas deferens.  My docs preform a "no scalpel" vasectomy.  Having discussions with docs and coworkers and we are split which code to use for the "no scalpel" method.

Any input would be greatly appreciated!!!


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## Kelly_Mayumi

I found this in a Urology Coding Alert which is published by The Coding Institute:

Reader Question: Non-scalpel Vasectomy

Question: How do I code a bilateral �non-scalpel� vasectomy? What about a reversal?

Wisconsin Subscriber

Answer: Code 55250 (vasectomy, unilateral or bilateral [separate procedure], including postoperative semen examination) is for a vasectomy, but there is no separate code for a non-cutting procedure. As long as you are ligating the vas deferens, 55250 is appropriate for any technique or combination of techniques. If the �non-scalpel� technique takes a significant additional amount of time, append modifier -22 (unusual procedural services). 

The non-scalpel procedure is very similar to a traditional vasectomy, but there are no incisions or stitches, so healing is faster. A puncture is made in the scrotum with a pointed clamp, and the two vasa deferentia are lifted out. The vasa are cut, and a section of each may be removed as well. The two cut ends are cauterized and also may be tied or clipped. Code 55250 is bilateral, which means that the urologist can be paid only once for doing both sides. A reversal is coded 55400 (vasovasostomy, vasovasorrhaphy), which is the same code you would use for reversal of a standard vasectomy.


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## h8towa812

*lgc*

I believe the correct code is 55450 for a non scalpel vasectomy. If you look in the Coders Desk Reference the description of 55450 states the physician performs ligation of the vas deferens without cutting an incision in the skin. The procedue is done with an instrument pressed against the structues of the scrotum and activated sequentially. The instrument punctures the skin and cuts the spermatic cord, then clips the cord on each side of the cut area. The procedure is repeated on the oposite side and the punture wounds are gandaged.

The discription of code 55250 states the physician makes an incision into the skin through the scrotal wall to expose the tubular structures. The vas deferens is cut in two places and a section removed the cut ends are cauterized and tied with suture material. The incision is closed in layers by suturing. Repeat on opposite side.


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