Urology Coding Alert

Question: Our urologist performed a vasectomy on the right side in the office under local anesthesia, but because of severe pain during the procedure the physician discontinued the office procedure. Then he performed the procedure on the left side in an ASC on another day under general anesthesia. How should I code for these procedures? Since a vasectomy is either unilateral or bilateral, should I just wait and bill for the procedure in the ASC?

California Subscriber

 Answer: Your best bet for reporting these procedures is to submit two 1500 forms. On the first 1500 form, report 55250 (Vasectomy, unilateral or bilateral [separate procedure], including postoperative semen examination[s]). Append modifier RT (Right side) and the date of the office visit.
 
You'll use place-of-service code 11 (Office). Use diagnosis codes V25.2 (Encounter for contraceptive management; sterilization) and V64.3 (Procedure not carried out for other reasons) with this claim.
 
Tip: You may also want to append modifier 53 (Discontinued procedure) to 55250 to indicate that the physician discontinued the procedure for the well-being of the patient, most likely because of uncontrollable pain during the procedure. Since the vasectomy procedure may be either unilateral or bilateral, however, modifier 53 isn't essential.
 
Use a second 1500 form on the date the urologist performed the vasectomy in the ASC. Report 55250 and append modifiers 58 (Staged or related procedure or service by the same physician during the postoperative period) and LT (Left side), and use place-of-service code 24 (Ambulatory surgical center). You need to use modifier 58 since the physician performed the second procedure during the global period of the first as a staged procedure. Use diagnosis code V25.2 for this encounter.
 
Note: Some carriers include a 90-day global period for a vasectomy. In the first operative dictation, make sure your urologist indicates prospectively that the procedures will be staged.