Karen Posted Thu 18th of June, 2020 15:05:25 PM
One of my physicians was only able to perform a vasectomy on the right side in the office. The left side was involved with a hydrocele. another physician performed the left vasectomy and hydrocelectomy. How should the vasectomy portion be billed? 55250-52 for each doc? Since 55250 is bilateral or unilateral, it would be better financially to bill the office portion in full and do the hospital portion as no charge, but I am not sure if that is appropriate. What is your suggestion? Thank you so much for your help
SuperCoder Answered Fri 19th of June, 2020 10:56:54 AM
Thank you for your question.
As per the above documentation:
The best way for reporting these procedures is to submit two 1500 forms. On the first 1500 form, report 55250 (Vasectomy, unilateral or bilateral [separate procedure], including postoperative semen examination[s]). Append modifier RT (Right side) and the date of the office visit. Use place-of-service code 11 (Office).
Use a second 1500 form on the date the urologist performed the vasectomy in the hospital. Report 55250 and append modifiers 58 (Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period) and LT (Left side), and use place-of-service code 21 (inpatient).
Since we did know he would be coming back to have the left vasectomy done and was carried within the global day, we will use modifier 58 with 55250.
As per CMS National Coverage Determination (NCD) for sterilization, if the primary reason for a vasectomy is for sterilization, Medicare will not pay. “Payment may be made only where sterilization is a necessary part of the treatment of an illness or injury,”
Also, Some carriers include a 90-day global period for a vasectomy. In the first operative dictation, make sure your urologist indicates prospectively that the procedures will be staged.
Karen Posted Fri 19th of June, 2020 11:55:43 AM
The modifier crosswalk does not list RT and LT as appropriate for 55250...I will try it though and see what happens. thank you for your assistance, I truly appreciate it.
SuperCoder Answered Mon 22nd of June, 2020 15:27:07 PM
You are most welcome.
In the above scenarion, Lt and Rt will be just informational.