Wiki Vasectomy

[knlewis]

We performed a Vasectomy on a patient and the patient never returned for a postoperative semen analysis. We received a letter from the insurance company to recoup the money for the procedure because a postop semen analysis was not documented. Any idea how I should fight this as my understanding of 55250 is that it includes the postop semen analysis which means we can't bill for it but not that we have to perform it in order bill a 55250.

 

[cray1957]

If insurance recoups due to the patient not following up then I would ask the carrier if you can bill the patient his it is his negligence.

 

[Coder2468]

I've never had this happen. I would appeal their recoupment - if the patient chooses to not undergo the semen analysis for some reason, you can't make them do it. My understanding of 55250 is the same as yours. What carrier is recouping it?

 

[ckkohler]

Recoupment of Vasectomy

I would also contact the patient - let him know the insurance carrier is trying to recoup the payment. Check if this policy falls under ERISA - meaning if the insurance is provided to the patient by his employer/spouse's employer and the employer is NOT a government and/or religious entity ... they don't have the right to recoup from you. The carriers try but when you fight the recoupment with ERISA the provider usually wins. Most carriers are banking on fact that provider staff aren't aware of their legal rights under ERISA.

 

[alinton01]

Vasectomy recoup

I have worked in Urology for almost 20 years and I have never seen this. Yes the code includes post op semen analysis but I would argue the patient was instructed to, but failed to follow up. Keep us posted on this one!