Wiki Post-Vas Semen Analysis Billing?

[myelsik]

The description for the code 55250 is shown as "Vasectomy, including postoperative semen examination(s)"...however the bundling matrix in AUA shows that 55250 and 89310 are "Ok to bill". Our physicians are wanting to know if we can charge for semen analysis after the 90 day global of the vas, or even if it is just the first semen analysis that is included in the procedure. Any ideas?

Thank you!

Mallory Yelsik, CPC, CUC

 

[CodingKing]

NCCI edits do not account for all possible incorrect coding scenarios so lack of an edit is not an approval to report separately. Its a standard of care to perform the test and the CPT says its included so its not separately reportable. This applies even if you hold off (on purpose or otherwise) until after the global period has ended.

 

[JEYCPC]

You nailed it CodingKing. That is something I have to remind myself constantly. Read the code, check the edits, apply common sense.

 

[michelleaapc2012]

What about using G0027 instead of 89310? Is that appropriate?

 

[JEYCPC]

The description for the code 55250 is shown as "Vasectomy, including postoperative semen examination(s)"

55250 still includes semen analysis. So that would be no to G0027.

 

[CodingKing]

What about using G0027 instead of 89310? Is that appropriate?

Its still considered a semen analysis so no. Vasectomy is always followed by semen analysis to make sure it was completed properly, AMA constantly bundles things that are always done.