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We had a good read. For the benefit of yourself. Be sure to read to the end. I want you to get good knowledge from General Surgical Associates.Vasectomies are very coarse in most urology practices. But selecting the permissible codes to article can sometimes prove very challenging, right from the pre-vasectomy "consultation" visit that most urologists perform. You could be costing your practice hundreds over the policy of one year if you're not billing out each piece of the vasectomy process. Here are four steps to ensure that you capture all the refund your urologist deserves.
1. Don't be in a hurry to assign consult codes for the first visit
Prior to performing a vasectomy process a urologist meets with the patient to discuss the policy and makes sure that the patient understands the outcome of the policy and then undergo this optional sterilization. You should article this office visit using the approved E/M code, says Kelly Young, a coder with Scottsdale center for Urology in Scottsdale, Ariz.
The real challenge comes when you try to outline out either you should article an office visit E/M code or a consultation code.
Depending on your urologist's documentation, you can pick from the consultation codes (99241-99245, Office consultation for a new or established patient...), a new patient (99201-99205, Office or other patient visit for the estimate and administration of a new patient...), or established patient (99211-99215, Office or other patient visit for the estimate and administration of an established patient...) codes.
Don't lose out on your Dollars: You would be sacrificing on your Dollars if you skip reporting the pre-vasectomy office visit. Suppose, your urologist performs a level-three new patient visit (99203), you'll earn .97 (the unadjusted fee for 99203, 2.55 Rvus, times the 2009 conversion rate of .0666) in expanding to the policy code, and if your urologist performs a level-three consultation, you'll earn 5.15 (the unadjusted fee for 99203, 3.47 Rvus, times the 2009 conversion rate of .0666) in expanding to the policy code.
Remember: If the patient is new to your office, article a new patient visit using codes 99201-99205. However, if the urologist (or other urologist in the same practice) has seen the patient within the past three years, article an established patient office visit (99211-99215), and not a new patient visit.
Beware: Don't 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 article a consultation code (99241-99245), the visit must meet the requirements of a consultation. There must be a documented invite from the requesting physician; a article of the urologist stating his findings, opinions, and advice in the patient's chart; and a article that's sent back to the requesting doctor.
Michael A. Ferragamo Md, Facs, clinical assistant professor of urology, State University of New York, Stony Brook says, "Since the modern rule changes for consultations come from Medicare 2006 policy changes (Transmittal 788) and since most men seeking vasectomies for sterilization do not have Medicare as their primary assurance carrier, the patients sent to urologists by physicians most often represent consultation requests, hence, they should be billed and coded accordingly if all criteria for a consultation are met."
Diagnosis aid: The most approved Icd-9 code for the pre-vasectomy examination, either it's a consultation or a new/established patient visit is V25.09 (Encounter for contraceptive management; normal 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 cost for any pre-vasectomy exam 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 cost for a pre-vasectomy assistance in most cases.
Check, which diagnostic code is favorite by your payer. The Scottsdale center for Urology uses V25.2 as 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
If your urologist performs the vasectomy policy on the same day as the pre-vasectomy office visit make sure that you append modifier 57 (Decision for surgery) to the E/M code you report. Also ensure that the urologist's documentation supports a isolate E/M code, the E/M assistance must go above and beyond the E/M that's inherent to the procedure.
Avoid bundled payment: Your urologist can conduct the assistance on isolate days if you want to make sure that your payer will not bundle the pre-vasectomy visit with the vasectomy procedure. Many urologists do this anyway to give the patient time to present his options and make the final decision about surgery. Above that, your office will have time to present the patient's benefits.
Alice Kater, Cpc, Pcs, coder for Urology company of South Bend, Ind says, "We never accomplish the policy the same day as 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 exam and present of systems. When they leave the physician, they schedule their policy for the next available, and convenient, vas opening."
3. settle on a Code Based on the Type of Procedure
You'll have to go straight through the documentation to see which technique your urologist used, so that you can article the actual vasectomy procedure. Then pick one of these three codes:
55250 - Vasectomy, unilateral or bilateral (separate procedure), together with postoperative semen examination(s). "This Cpt Codes is the most coarse 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 should article 55250, 55450, or 55559 just once per patient regardless of either the urologist performs the policy 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 consist of the local or regional anesthesia that the urologist administers, so do not 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 normally included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) for incommunicable 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 will still reimburse for local anesthesia administered by the urologist and for a tray charge. Check with the exact carrier. One may bill incommunicable or commercial carriers Hcpcs code S0020 (Injection, bupivicaine Hcl, 30 ml) for refund of the anesthetic agent used," he adds.
There is no Cpt code for laparoscopic vasectomy so when your urologist performs this procedure, normally at the same time a normal surgeon is performing a laparoscopic hernia repair, article the unlisted code 55559.
Hint: Make sure that you submit a detailed article 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, tool used, and time involved.
4. consist of Semen diagnosis in the policy Code
After the vasectomy, the urologist must contemplate the semen to conclude the eventual absence of sperm. These examinations are included in the policy code, so your urologist should document the service, but you should not article them separately.
If your office laboratory is not credentialed (Clia certification) to accomplish these post-vasectomy semen analyses, face laboratory evaluations will be valuable and that would effect in an additional 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 wee semen exam seeing only for the presence or absence of sperm.
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