Get $125 Extra In Vasectomy-Related Payment With This 4-Step Coding Process

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Vasectomies are very common in most urology practices. But selecting the best codes to report can sometimes prove very challenging, right from the pre-vasectomy “consultation” visit that almost all urologists perform. You could be costing your practice hundreds over the course of one year if you’re not billing out each piece of the vasectomy process. Listed here are four steps to ensure that you capture all the reimbursement your urologist deserves.

1. Don’t be in a hurry to assign consult codes for the primary visit

Previous to performing a vasectomy process a urologist meets with the patient to debate the procedure and makes sure that the patient understands the outcome of the procedure and then undergo this elective sterilization. It’s best to report this office visit using the appropriate E/M code, says Kelly Young, a coder with Scottsdale Center for Urology in Scottsdale, Ariz.

The real challenge comes whenever you try to figure out whether it is best to report an office visit E/M code or a consultation code.

Depending in your urologist’s documentation, you may choose from the consultation codes (99241-99245, Office consultation for a brand new or established patient…), a brand new patient (99201-99205, Office or other outpatient visit for the evaluation and management of a brand new patient…), or established patient (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient…) codes.

Don’t lose out on your Dollars: You can be sacrificing on your Dollars if you happen to skip reporting the pre-vasectomy office visit. Suppose, your urologist performs a level-three new patient visit (99203), you will earn $91.97 (the unadjusted fee for 99203, 2.55 RVUs, times the 2009 conversion rate of $36.0666) in addition to the procedure code, and in case your urologist performs a level-three consultation, you will earn $125.15 (the unadjusted fee for 99203, 3.47 RVUs, times the 2009 conversion rate of $36.0666) in addition to the procedure code.

Remember: If the patient is new to 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 within the past three years, report an established patient office visit (99211-99215), and not a brand new patient visit.

Beware: Do not let the term “consultation” in the physician’s documentation trick you. Often practices, physicians, and even patients refer to the pre-vasectomy visit as a consultation. However, to report a consultation code (99241-99245), the visit must meet the requirements of a consultation. There should be a documented request from the requesting physician; a record of the urologist stating his findings, opinions, and advice in the patient’s chart; and a report that’s sent back to the requesting doctor.

Michael A. Ferragamo MD, FACS, clinical assistant professor of urology, State University of recent York, Stony Brook says, “For the reason that recent rule changes for consultations come from Medicare 2006 policy changes (Transmittal 788) and since most men seeking vasectomies for sterilization shouldn’t have Medicare as their primary insurance carrier, the patients sent to urologists by physicians most frequently represent consultation requests, hence, they must be billed and coded accordingly if all criteria for a consultation are met.”

Diagnosis aid: Essentially the most appropriate ICD-9 code for the pre-vasectomy examination, whether it’s a consultation or a new/established patient visit is V25.09 (Encounter for contraceptive management; general counseling and advice; other).

Important point: Many payers have a perception that code V25.09 is a “family planning advice,” and pertain only to the female partner, and hence, they will deny payment for any pre-vasectomy examination of the male when you use this diagnosis. So use V25.2 (Encounter for contraceptive management; sterilization, admission for interruption of…vas deferens) in its place, with this you can expect payment for a pre-vasectomy service typically.

Check, which diagnostic code is preferred by your payer. The Scottsdale Center for Urology uses V25.2 because the diagnosis code. However, “we bill… with V25.09,” says Kim Kerckhoff, CCA, coder for Alpine Urology in Anchorage, Alaska.

2. Use modifier 57 for Same-Day E/M and Procedure

In case your urologist performs the vasectomy procedure on the identical day because the pre-vasectomy office visit just be sure you append modifier 57 (Decision for surgery) to the E/M code you report. Also ensure that the urologist’s documentation supports a separate E/M code, the E/M service must go above and beyond the E/M that is inherent to the procedure.

Avoid bundled payment: Your urologist can conduct the service on separate days if you wish to ensure that your payer is not going to bundle the pre-vasectomy visit with the vasectomy procedure. Many urologists do this anyway to provide the patient time to review his options and make the ultimate decision about surgery. Above that, your office could have time to review the patient’s benefits.

Alice Kater, CPC, PCS, coder for Urology Associates of South Bend, Ind says, “We never perform the procedure the identical day because the vas consultation. The patient and wife/partner will come in for the consult, view a movie, and speak extensively with the physician following the examination and review of systems. Once they leave the physician, they schedule their procedure for the subsequent available, and convenient, vas opening.”

3. Select a Code Based on the kind of Procedure

You may need to go through the documentation to see which technique your urologist used, so to report the actual vasectomy procedure. Then choose one of those three codes:

– 55250 – Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s). “This CPT Codes is the commonest code used for vasectomy for voluntary sterilization,” Ferragamo explains.
– 55450 – Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate procedure). “Coders rarely use this code for a vasectomy for voluntary sterilization,” Ferragamo says.
– 55559 – Unlisted laparoscopy procedure, spermatic cord for a laparoscopic vasectomy.

Add V25.2 to the vasectomy procedure, says Kerckhoff.

Clue: You must report 55250, 55450, or 55559 just once per patient no matter whether the urologist performs the procedure on one or both sides. The urologist usually, but not always, performs the procedure, cutting the vas deferens and suturing the ends, on both the left and right sides. So don’t change your urology coding even if your urologist cuts and sutures only one side (for a patient having only one testicle).

Note: These codes also include the local or regional anesthesia that the urologist administers, so don’t code any local anesthesia administered for those services separately.

Surgical trays: Use the HCPCS code A4550 (Surgical trays) or CPT code 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) for private or commercial payers, few of them reimburse for a surgical tray/supplies.

“Medicare will not reimburse for anesthesia administered by the surgeon or urologist, or for tray charges,” Ferragamo warns. “However, there are a few commercial carriers that may still reimburse for local anesthesia administered by the urologist and for a tray charge. Check with the specific carrier. One may bill private or commercial carriers HCPCS code S0020 (Injection, bupivicaine HCL, 30 ml) for reimbursement of the anesthetic agent used,” he adds.

There isn’t a CPT code for laparoscopic vasectomy so when your urologist performs this procedure, usually at the identical time a general surgeon is performing a laparoscopic hernia repair, report the unlisted code 55559.

Hint: Just remember to submit an in depth report back to your payer and compare, or benchmark, the laparoscopic vasectomy to 55550 (Laparoscopy, surgical, with ligation of spermatic veins for varicocele), with respect to the surgical work, technology, equipment used, and time involved.

4. Include Semen Analysis in the Procedure Code

After the vasectomy, the urologist must examine the semen to find out the eventual absence of sperm. These examinations are included within the procedure code, so your urologist should document the service, but you shouldn’t report them separately.

In case your office laboratory just isn’t credentialed (CLIA certification) to perform these post-vasectomy semen analyses, outside laboratory evaluations will be necessary and that will lead to an extra cost to the patient. However, under these circumstances your urologist should never lower his fee or modify his urology coding. Practices often make special arrangements with most laboratories for a reduced fee for a limited semen examination looking only for the presence or absence of sperm.

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