Urology Coding Alert

Vasectomy coding can be complicated by one simple fact: Managed-care companies arent always ready to pay for it. Medicare doesnt cover vasectomies at all. And while many private health plans are willing to pay for vasectomies, some are not. Brenda Oliver, billing office manager for Pioneer Valley Urology, a six-urologist practice in Springfield, Mass., explains the four steps to coding vasectomies.

1. Sending a consent form and waiver. Before the patient even comes in for the visit, Olivers office sends him a vasectomy package. This includes a consent form and a brochure describing the procedure and its effects. The consent form is very important, says Oliver. When the patient comes in for the first visit, he brings the form, which has been signed by him and his wife. We need the wifes signature on the consent form too because when we didnt have it, sometimes the wife would come in later and say, I didnt know he had this, says Oliver. These women would be very upset, thinking that they had been tricked into not having any more children. It got to be so difficult for the office that the wifes consent was required.

Now, because of the problem with some insurance companies not paying for vasectomies at all, Oliver is adding a waiver to the packet. The exact wording of the waiver hasnt been determined yet, but it will tell the patient to tell the insurance company that he is going to have a vasectomy. Were going to tell them the code 55250 and tell them to talk to the insurance company to find out about payment, says Oliver. Its supposed to be the patients responsibility, and we are going to make it that.

The office used to call insurance companies after the patients first visit to find out if vasectomies were covered. Wed spend a lot of time on hold with the insurance companies, she says. It was very time consuming, and thats why were starting the new policy with the waiver.

The waiver language itself also will cover a situation in which a patient may think the insurance company will pay, but the company really wont. It will say something along the lines of, If for some reason my insurance company rejects the claim, I understand that I am responsible for the bill, says Oliver.

2. Coding the first visit. The first visit is either a consultation (99241-99245) or, more likely, a new patient office visit (99201-99205). It also could be an established patient office visit (99212-99215) if he has been seen by the urologist within the past three years. Oliver uses diagnosis code V25.2 (encounter for contraceptive management; sterilization) for the initial visit (consult [...]