Go to V25.x for your diagnostic code code.
Vasectomy is very common in most urological practices. But choosing the right codes for the message can sometimes be very difficult, right from prior consultation with the “consultation” that most urologists conduct. You could spend your practice on a hundred for one year if you do not rely on each part of the vasectomy process. Here are four steps to ensure the capture of all reimbursements described by your urologist.
1. Do not rush to assign codes for the first visit.
Before performing the vasectomy process, the urologist meets with the patient to discuss the procedure and make sure that the patient understands the result of the procedure, and then undergoes this electrical sterilization. You must report this office visit using the appropriate E / M code, ”says Kelly Young, a coder with the Scottsdale Center for Urology in Scottsdale, Arizona.
The real problem arises when you are trying to find out whether you should report a visit to an E / M office or a consultation code.
Depending on your urologist documentation, you can choose from consultation codes (99241-99245, consultation in the office for a new or an established patient ...), a new patient (99201-99205, an office or another envoy to visit, assessment and management of a new patient .. .), or an established patient (99211-99215, the Office or another envoy to evaluate and manage an established patient ...).
Do not lose your dollars A: You will donate your dollars if you miss a report on a visit to the preschetation. Suppose that your urologists will reach a new level with three or three patients (99203), you will bring $ 91.97 (unadjusted fee for 99203, 2.55 RVU, compared with 2009 in the amount of $ 36.0666) in addition to the procedure code and if your urologist earns you $ 125.15 (unadjusted contribution for 99203, 3.47 RVU, recalculated for 2009 in the amount of $ 36.0666) in addition to the procedure code.
Remember : If the patient is not familiar with your office, report a new patient visit using codes 99201-99205. However, if the urologist (or another urologist in the same practice) has seen the patient for the past three years, report the visit to the hospital (99211-99215), and not the new visit of the patient.
beware : Do not let the term "consultation" in the doctor's documentation fool you. Often, practitioners, doctors, and even patients refer to a visitation of a pre-evasectomy as a consultation. However, in order to communicate the consultation code (99241-99245), the visit must comply with the consultation requirements. A documented request from a requesting physician is required; record of the urologist about statement of his conclusions, opinions and recommendations on the patient's chart; and the report that was sent back to the requesting doctor.
Michael A. Ferragamo MD, FACS, Clinical Assistant Professor of Urology, State University of New York, Stony Brook says: “Because recent changes in the rules for consultation concern changes in Medicare 2006 policy (Transmittal 788), and since most men seeking vasectomy for sterilization are not they have Medicare as the main insurance carrier, patients send doctors to urologists most often representative requests for counseling, since they must be invoiced and coded accordingly if all the criteria for consultation are met ultiations.
Diagnostic aid : The most appropriate ICD-9 code for a pre-vasectomy examination, be it a consultation or a new / established patient visit, is V25.09 (“Meeting for contraceptive management, general counseling and counseling”, other).
Important point : Many taxpayers have an idea that code V25.09 is “family planning advice” and applies only to a female partner, and therefore they will refuse to pay for any previous examination of a man’s vasectomy when you use this diagnosis. Therefore, use V25.2 (Encounter for contraceptive management, sterilization, reception for interruption ... vas deferens) in its place, with this you can in most cases pay for a preliminary vasectomy.
Check which diagnostic code your payer prefers. The Scottsdale Urology Center uses V25.2 as a diagnostic code. However, "we have the bill ... from V25.09," says Kim Kerkhoff, CCA, coder for Alpine Urology in Anchorage, Alaska.
2 Use modifier 57 for E / M for the day and procedure
If your urologist performs the vasectomy procedure on the same day as the prevasectomy visit, be sure to add the modifier 57 (solution for the operation) to the E / M code that you report. Also make sure that the urologist documentation supports a separate E / M code, the E / M service should go above and above the E / M, which is inherent in the procedure.
Avoid nested payments : Your urologist can do the maintenance on separate days if you want to make sure that your payer will not associate a preliminary vasectomy with a vasectomy procedure. Many urologists do this one way or another to give the patient time to consider his options and make the final decision about the operation. Above this, your office will have time to consider the benefits of the patient.
Alice Cather, CPC, PCS, coder for Urology Associates of South Bend, Ind says: “We never perform the procedure on the same day as the vas consultation, talk a lot with the doctor after examining and reviewing the systems. When they leave the doctor, they plan their procedure for the next available and convenient discovery of vas. "
3 Select a code based on the type of procedure.
You will need to go through the documentation to find out which method your urologist used, so that you can report the actual vasectomy procedure. Then select one of these three codes:
- 55250 - vasectomy, unilateral or bilateral (separate procedure), including postoperative sperm (s). "This CPT codes is the most common code used for vasectomy for voluntary sterilization, ”explains Ferragamo.
- 55450 - Ligation (percutaneous) vas deferens, unilateral or bilateral (separate procedure). “Coders rarely use this code for vasectomy for voluntary sterilization,” says Ferragamo.
- 55559 - Private laparoscopy procedure, spermatic cord for laparoscopic vasectomy.
Add V25.2 to the vasectomy procedure, says Kerkhoff.
Clue : You should only report 55250, 55450 or 55559 once per patient, regardless of whether the urologist processes the procedure on one or both sides. The urologist usually, but not always, performs the procedure, cutting the deferent duct and stitching the ends on both the left and right sides. So do not change your urological coding even if the urologist cuts and lays only one side (for a patient with only one testicle).
The note : These codes also include local or regional anesthesia, which is administered by the urologist, so do not code the local anesthesia administered for these services separately.
Surgical trains : Use code HCPCS A4550 (surgical trains) or code CPT 99070 (accessories and supplies [except spectacles]provided by a doctor in addition to those usually included in office visits or other services rendered [list drugs, trays, supplies , or materials provided]) for private or commercial payers, few are refundable for the surgical tray / accessories.
“Medicare will not compensate for the anesthesia that the surgeon or urologist is doing, or for the tray,” Ferragamo warns. “However, there are several commercial carriers that will still return for local anesthesia administered by the urologist and for charging the tray. Please contact your specific carrier.) To recover the used anesthetic, ”he adds.
There is no CPT code for laparoscopic vasectomy, so when your urologist performs this procedure, usually at the same time, the general surgeon performs a laparoscopic hernia, report unregistered code 55559.
hint : Ensure that you provide a detailed report to your payer and compare or compare laparoscopic vasectomy with 55550 (laparoscopy, surgical, with varicocele ligation of the spermatic veins) regarding surgeries, technology, equipment used and time.
4. Include semen analysis in procedural code
After a vasectomy, the urologist must examine the sperm to determine the historical absence of sperm. These exams are included in the procedure code, so your urologist must document this service, but you should not report it separately.
If your office lab is not certified (CLIA certification) to perform these semen analyzes after vasectomy, additional laboratory evaluations are required and this will result in additional costs for the patient. However, under these conditions, your urologist should never omit a fee or modify his urological coding. Practitioners often hold special events with most laboratories for less for limited sperm, considering only the presence or absence of sperm.
