toria11
Guru
The patient had a vasectomy performed which was paid in full by the insurance. It was noted at that time that the patient would need to undergo scrotal exploration to identify the left vas and complete the vasectomy. The provider was already paid for a complete vasectomy. Are they able to bill for the second procedure to find the left vas and finished the vasectomy? If so, would it be okay to use 55250 again? Thanks.
The patient is a 26-year-old fertile male who initially presented
for vasectomy. The patient underwent attempted vasectomy two weeks ago, which the right side was
successful as the vas was excised and confirmed by pathology. However, I could not definitely find his
vas deferens on his left scrotum. The treatment options were discussed and he elected to proceed begin
under general anesthetic to complete his vasectomy. After risks, benefits, and alternatives were explained
to the patient, the patient elected to proceed, and informed consent was obtained.
DETAILS OF PROCEDURE: The patient was properly identified and brought back to the operating
room where he was laid supine on the operating table. A proper time-out was performed. Under the
direction of Anesthesiology, the patient was intubated and induced under general anesthetic. Ancef 2 g IV
was given within one hour of the start of the procedure. The patient was placed in the dorsal lithotomy
position and prepped and draped in a normal sterile surgical fashion. A 2 cm transverse incision was made
on the left hemiscrotum and his testicle was delivered. I carefully dissected off the subcutaneous tissues
to isolate the cord; however, both visually and however did not see any obvious vas deferens and also
palpated the cord and did not feel vas deferens as well. I then opened up the tunic sac to directly expose
the testicle and looked at the epididymis. I did not see vas deferens and epididymis appeared to be atretic
with appeared to be sinus for his tube also visible. I then called my pattern Dr. D**** to take a second
look and he felt that the vas was blind and atretic as well. I did excise what appeared to be the atretic left
vas and we will send off to the pathologist. Hemostasis was then achieved with pinpoint electrocautery.
Again the epididymis appeared to be atretic. The testicle was viable and appeared to be healthy. At this
time, I then put it back into the proper orientation in the left hemiscrotum with the lateral sulcus facing
lateral. At this time, we then closed the incision two layers with 3-0 Vicryl and 4-0 chromic. This
concluded the procedure. The patient was extubated and sent to the recovery room in stable condition.
Pain meds and antibiotic sent to his pharmacy. He will be discharged home. Follow up in 7 to 10 days.
We will then likely need to retain several semen analysis in the next few months to make sure that he has
a negative semen analysis.
The patient is a 26-year-old fertile male who initially presented
for vasectomy. The patient underwent attempted vasectomy two weeks ago, which the right side was
successful as the vas was excised and confirmed by pathology. However, I could not definitely find his
vas deferens on his left scrotum. The treatment options were discussed and he elected to proceed begin
under general anesthetic to complete his vasectomy. After risks, benefits, and alternatives were explained
to the patient, the patient elected to proceed, and informed consent was obtained.
DETAILS OF PROCEDURE: The patient was properly identified and brought back to the operating
room where he was laid supine on the operating table. A proper time-out was performed. Under the
direction of Anesthesiology, the patient was intubated and induced under general anesthetic. Ancef 2 g IV
was given within one hour of the start of the procedure. The patient was placed in the dorsal lithotomy
position and prepped and draped in a normal sterile surgical fashion. A 2 cm transverse incision was made
on the left hemiscrotum and his testicle was delivered. I carefully dissected off the subcutaneous tissues
to isolate the cord; however, both visually and however did not see any obvious vas deferens and also
palpated the cord and did not feel vas deferens as well. I then opened up the tunic sac to directly expose
the testicle and looked at the epididymis. I did not see vas deferens and epididymis appeared to be atretic
with appeared to be sinus for his tube also visible. I then called my pattern Dr. D**** to take a second
look and he felt that the vas was blind and atretic as well. I did excise what appeared to be the atretic left
vas and we will send off to the pathologist. Hemostasis was then achieved with pinpoint electrocautery.
Again the epididymis appeared to be atretic. The testicle was viable and appeared to be healthy. At this
time, I then put it back into the proper orientation in the left hemiscrotum with the lateral sulcus facing
lateral. At this time, we then closed the incision two layers with 3-0 Vicryl and 4-0 chromic. This
concluded the procedure. The patient was extubated and sent to the recovery room in stable condition.
Pain meds and antibiotic sent to his pharmacy. He will be discharged home. Follow up in 7 to 10 days.
We will then likely need to retain several semen analysis in the next few months to make sure that he has
a negative semen analysis.