Urology Coding Alert

Question: My urologist made a low inguinal incision to the top of the left hemiscrotum and proceeded with dissection through Scarpa’s fascia to the level of the external ring. My urologist identified the cord structures. They delivered the left testis and palpated the very hard cord. This was followed to the internal ring where it softened and followed distally to the epididymis. My urologist suture ligated the tube at either end and removed the indurated tube. There appeared to be inflammatory discharge from the tube. My urologist irrigated the area and injected the proximal and distal vas sections with Kenalog. Next, they opened the tunica vaginalis, examined the testis, and found it to have good blood supply. In view of this, my urologist elected to attempt keeping the testis, which they placed back into the left hemiscrotum. My urologist reconstructed the external ring with interrupted 3-0 chromic, then reapproximated the Scarpa’s with 3-0 chromic. They closed the incision with two layers of 4-0 Monocryl. My urologist injected the entire area with Marcaine 0.5 percent plain and completed skin closure with Dermabond. The diagnosis and reason for surgery was inflamed epididymis and cord. The pathology was vas deferens calcification and inflammation. It was negative for malignancy. Can I report 55250 for this procedure?

AAPC Forum Subscriber

Answer: Code 55250 (Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)) may be the correct code to describe this procedure. However, you may not be reimbursed.

From a clinical urological point of view, a vasectomy may be indicated as necessary for the treatment of recurrent epididymitis. Payers may not consider the procedure medically necessary for the diagnosis of inflamed epididymis and cord or calcified and inflamed vas deferens. Their policies may only consider sterilization-related diagnoses, such as Z30.2 (Encounter for sterilization), as payable with 55250.

You should submit clear and complete documentation supporting the medical necessity of the procedure. Unfortunately, the payer may not accept your medical reason for this indication.