Urology Coding Alert

Tip: You should separately code semen analysis

Follow these four steps to ensure you're capturing complete reimbursement for your urologist's vasectomy services.

1. The first visit. Based on the requirements of your carrier, report either a consultation code (CPT 99241 -CPT 99245 ) or an office visit code (99201-99205 for new patients, or 99212-99215 for an established patient).

Use ICD-9 code V25.2 (Sterilization, admission for interruption of ... vas deferens) most of the time, and when instructed by a particular carrier use code V25.09 (Encounter for contraceptive management; general counseling and advice; other) as your diagnosis.

"We use V25.2 if a patient has decided he is proceeding with surgery, or V25.09 if the patient is unsure whether he wants to proceed with the vasectomy for our prevasectomy visit," says Kathy Peters, billing supervisor at Urology Associates Ltd. in Milwaukee, Wis. During this visit, the urologist discusses the procedure with the patient and, sometimes, the patient's wife. The urologist explains what the procedure entails and answers any questions the patient may have.

2. Coding the procedure. Report the procedure using 55250 (Vasectomy, unilateral or bilateral [separate procedure], including postoperative semen examination[s]), 55450 (Ligation [percutaneous] of vas deferens, unilateral or bilateral [separate procedure]), or for a laparoscopic vasectomy, 55559 (Unlisted laparoscopy procedure, spermatic cord). Link V25.2 (Sterilization, admission for interruption of ... vas deferens) to the vasectomy procedure.

3. Surgical trays. Use the HCPCS code A4550 (Surgical trays) or CPT code 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) for private or commercial carriers, some of which will reimburse for a surgical tray/supplies.

Note: Medicare never pays for surgical trays, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York, Stony Brook.

4. The semen analysis. After the vasectomy, the physician must examine the semen to determine the eventual absence of sperm. These examinations are included in the procedure code, so you should document the service but not report them separately.

If the urologist's office laboratory is not credentialed (CLIA certification) to perform these post-vasectomy semen analyses, outside laboratory evaluations will be necessary and result in an additional cost to the patient. However, under these circumstances the urologist should never lower his fee or modify his coding, Ferragamo says.