Urology Coding Alert

Question: I’m coding a procedure for a patient who received an in-office vasectomy. The urologist worked for 45 minutes on the left side and ended up having to abort because of swelling. However, the urologist did complete the right side. The patient was brought back six weeks later and had the left side done. What would be the correct way to code each of these services?

California Subscriber

Answer: You will code an in-office vasectomy as 55250 (Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)). As the code description states, you will code the procedure the same whether the physician performs a unilateral or bilateral vasectomy. Furthermore, because the code description includes both unilateral and bilateral services, there’s no need to append modifier 52 (Reduced services) to unilateral services. 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. Therefore, you will code the first visit at 55250.

For the second visit, you should consider the fact that the physician performs the procedure within the global period (90 days) of the original 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.