Urology Coding Alert

Some payers won't reimburse you for vasectomy procedures at all, so your first step should be to check with your payers to see if they will pay your urologist for the vasectomy codes you report.

"We do have some payers who don't pay for vasectomies," says Alice Kater, CPC, PCS, coder for Urology Associates of South Bend, Ind. "For example, we are near a Catholic university, and their insurance does not cover voluntary sterilization. Even though we are participating providers, we feel comfortable collecting up front for these surgeries as they are a noncovered benefit."

Medicare does not pay for vasectomies, cautions Kelly Young, a coder with Scottsdale Center for Urology in Scottsdale, Ariz. According to Medicare National Coverage Determinations Manual, Chapter 1, Part 4, Section 230.3, elective vasectomies are not paid if the reason for the procedure is sterilization, Kater explains.

Good practice: Check on the patient's coverage before your urologist performs the procedure. "We check benefits while the patient is in the waiting room and collect out-of-pocket costs at time of service," Young says. If the patient's insurance does not consider vasectomies to be a covered benefit, Young's practice has the patient sign an advance beneficiary notice (ABN) to ensure the urologist gets paid, and the patient understands that he is responsible for payment.

Alternative: "We tell our patients that they must contact their insurance themselves" to see if the vasectomy will be covered, says Kim Kerckhoff, CCA, coder for Alpine Urology in Anchorage, Alaska.

Tip: Check with the insurance company on whether it will pay for a vasectomy for voluntary sterilization in the male patient.

"Some carriers will pay for a vasectomy, but for other reasons such as recurrent epididymitis, not for sterilization," says Michael A. Ferragamo MD, FACS,

clinical assistant professor of urology, State University of New York, Stony Brook. "This should be clarified with the patient before performing the procedure."

Many practices have a relatively high rate of vasectomy no-shows -- patients who schedule a vasectomy appointment and never show up for the procedure. One way to lower your no-show rate for these procedures is to collect a deposit when the patient schedules the appointment or after the pre-vasectomy office visit.

"We started collecting a $100 prepay at the time the patient schedules the appointment about three months ago," Young says. "I was expecting some resistance to this policy; however, we have had very few complaints. This has cut the number of vasectomies no-shows by about 80 percent."

"We also require a deposit to schedule the office visit due to the number of no-shows and cancellations," Kerckhoff adds.