Urology Coding Alert

Answer: You will code an in-office vasectomy as 55250 (Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)). The procedure code encompasses both unilateral and bilateral vasectomy, so it’s coded the same regardless of whether the doctor performs one or both. Also, since the code already includes both types of services, there’s no requirement to add modifier 52 (Reduced services), which signifies reduced services, for unilateral procedures. While the reimbursement wouldn’t change if you do append modifier 52, it might result in a delayed payment due to the fact that claims that include modifier 52 often require further documentation (and a subsequent paper claim) to be reimbursed appropriately.

When considering the second visit, bear in mind that the doctor carries out the procedure within the global period, which is 90 days from the initial procedure. In order to indicate that the procedure is a staged and related procedure by the same physician within the global period, you will append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to 55250.