Hcpcs Level Ii Codes Are Not Used In Same-Day Surgery Get $125 Extra in Vasectomy-Related Payment With This 4-Step Coding Process

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

Return to V25.x for your diagnosis code option.

Vasectomies are very common in most urology practices. But choosing the proper codes to report can sometimes be very challenging, right from the pre-vasectomy “consultation” visit that most urologists do. It could cost your practice hundreds over the course of a year if you don’t bill for every piece of the vasectomy process. Here are four steps to make sure you get all the compensation you deserve from your urologist.

1. Don’t rush to give out consultation codes for the first visit

Before performing a vasectomy process, a urologist will meet with the patient to discuss the procedure and make sure the patient understands the consequences of the procedure and then undergo elective sterilization. You should report this office visit using the appropriate E/M code, says Kelly Young, a coder at the Scottsdale Center for Urology in Scottsdale, Ariz.

The real challenge comes when you try to determine whether you should report an office visit E/M code or a consultation code.

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

Don’t lose your Dollars: You may be sacrificing your Dollars if you skip reporting to the pre-vasectomy office visit. For example, your urologist performs a level-three new patient visit (99203), you will earn $91.97 (the unadjusted payment for 99203, 2.55 RVUs, times the 2009 conversion rate which is $36.0666) plus the procedure code, and if your urologist performs a level-three consultation, you will receive $125.15 (the unadjusted payment for 99203, 3.47 RVUs, times the 2009 conversion rate which is $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 in the past three years, report an established patient office visit (99211-99215), and not a new one. patient visit.

watch: Don’t let the term “consultation” in the doctor’s documentation fool you. Often practices, doctors, 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 must be a documented request from the requesting physician; a record of the urologist expressing his findings, opinion, and advice in the patient’s chart; and a report sent back to the requesting physician.

Michael A. Ferragamo MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook says, “Because the recent rule changes for consultations from the Medicare 2006 changes in policy (Transmittal 788) and since most men seeking vasectomies for sterilization do not have Medicare as their primary insurance carrier, patients referred by urologists to physicians often represent consultation requests, therefore, they should be billed and coded accordingly if all the criteria for a consultation are met.”

Help with diagnosis: The most appropriate ICD-9 code for the pre-vasectomy examination, whether it is a consultation or a new/established patient visit is V25.09 (Encounter for contraceptive administration; general advice and counsel; etc.).

Important point: Many payers have a perception that code V25.09 is “family planning counseling,” and only applies to the female partner, and therefore, they will not pay for any pre-vasectomy examination of the male if you use this diagnosis. So use V25.2 (Encounter for contraceptive management; sterilization, admission for interruption of…vas deferens) instead, with it you can expect payment for pre-vasectomy services in most cases.

Check, which diagnostic code your payer prefers. The Scottsdale Center for Urology uses V25.2 as the diagnostic code. However, “we charge … 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

If your urologist performs the vasectomy procedure on the same day as the pre-vasectomy office visit make sure you add 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 should exceed the E/M that is in the procedure.

Avoid bundled payments: Your urologist may perform the service on different days if you want to make sure your payer does not bundle the pre-vasectomy visit with the vasectomy procedure. Many urologists do this to give the patient time to review his options and make a final decision about surgery. On top of that, your office has time to review patient benefits.

Alice Kater, CPC, PCS, coder for Urology Associates in South Bend, Ind. says, “We never do the procedure on the same day as the vas consultation. The patient and spouse/partner come in for the consultation, look- watch a movie, and talk to multiple doctors after checking and reviewing the systems. When they leave the doctor, they schedule their procedure for the next available, and convenient, vas opening.”

3. Select Code Based on Type of Procedure

You need to go through the documentation to see what technique your urologist used, so you can report the actual vasectomy procedure. Then choose one of these three codes:

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

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

Clue: You must report 55250, 55450, or 55559 only once for each patient regardless of whether the urologist performed 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 the left and right side. So don’t change yours urology coding even if your urologist cuts and stitches one side (for a patient with only one testicle).

NOTES: These codes also include local or regional anesthesia administered by a urologist, so do not code any local anesthesia provided for services separately.

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

“Medicare will not pay for anesthesia administered by a surgeon or urologist, or for tray fees,” Ferragamo cautioned. “However, there are some commercial carriers that will still pay for urologist-administered local anesthesia and for the tray fee. Check with the specific carrier. One can pay by private or commercial carriers HCPCS code S0020 (Injection, bupivicaine HCL, 30 ml ) for reimbursement of the anesthetic agent used,” he added.

There is no CPT code for laparoscopic vasectomy so if your urologist performs this procedure, usually at the same time a general surgeon performs a laparoscopic hernia repair, report the unlisted code 55559.

Hint: Make sure you submit a detailed report to your payer and compare, or benchmark, the laparoscopic vasectomy with 55550 (Laparoscopy, surgical, with ligation of the spermatic veins for varicocele), in relation to the surgical operation, technology, equipment used, and time involved.

4. Include Semen Analysis in the Procedure Code

After the vasectomy, the urologist should examine the semen to determine whether sperm are present. These exams are included in the procedure code, so your urologist should document the service, but you should not report it separately.

If your office laboratory is not credentialed (CLIA certification) to perform this semen analysis after vasectomy, tests outside the laboratory will be required and that will result in additional costs to the patient. However, under these circumstances your urologist should not lower his fee or change his urology coding. Practices often make special arrangements with most laboratories for a reduced fee for a limited semen analysis that only looks for the presence or absence of sperm.

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