Urology Coding Alert

Question: Code HCPCS G0027 is listed as a providerperformed microscopic procedure to test for the presence of sperm post-vasectomy. Would CPT 89321 be the equivalent?

Florida Subscriber

Answer: Yes, codes G0027 (Semen analysis; presence and/or motility of sperm excluding huhner) and 89321 (Semen analysis; sperm presence and motility of sperm, if performed) are equivalent.

You'll need to check with each payer to determine which code to report. For Medicare, use 89321.

Keep in mind: Your practice is not allowed to perform many basic laboratory services without Clinical  Laboratory Improvement Amendments (CLIA)-waived status. So if your practice does not get the waiver, you could be missing out on possible pay for some simple screens, such as the semen analysis tests.

If your practice has CLIA-waived status, you can  perform (and bill for) these tests and others. For your practice to perform CLIA-waived testing, Medicare requires that you:

• Enroll in the CLIA program by obtaining a certificate and pay the certificate fee every two years.

• Follow the manufacturers' instructions for the waived tests.

• Notify your state agency of any changes in ownership, name, address, or director within 30 days, or if you wish to add tests that are more complex; and allow inspections by a CMS agent, such as a surveyor from the state agency (Your laboratory is not subject to a routine survey or inspection).

• Append modifier QW (CLIA-waived test) to the code you're reporting for the test.

For more info: Check out the application for the CLIA waiver at www.cms.hhs.gov/cmsforms/downloads/cms116.pdf.