Urology Coding Alert

Question: Can you please tell me which ICD-10-CM code supports CPT^® code 55250 (Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s))? We have been using Z30.2 (Encounter for sterilization), but we are receiving some requests for more documentation and unsure if maybe Z98.52 (Vasectomy status) is a better diagnosis code to use. Also, is a vasectomy always considered a medically necessary procedure? Per the Centers for Medicare & Medicaid Services (CMS) guidelines, for a payment to be made on this procedure, it should be documented as an illness or injury and not an elective procedure.

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Answer: You should report Z30.2. Code Z98.52 would not be the correct option if the patient is having a vasectomy (55250) because this code is used for patients who have had the procedure already. However, if your payer requires documentation, you should provide it with your initial submission of the claim. Your payer may require a copy of the patient’s consent for all sterilization procedures.

As for payment for 55250, a vasectomy is a payable service for sterilization of the male. It is an exception to the rule of illness or injury as per the CMS’ available guidelines.