During vasectomy consultations, usually a patient is sent by his primary care physician. If you follow Medicare rules for consultations, then there is no problem in determining whether this represents a consult or not, and you would bill a new patient visit, especially if you haven't seen the patient before, at 99204. For private commercial carriers who do not follow the Medicare rules for consultations and continue to follow the older rules, you can bill consultations for that visit at 99241 to 99245 if criteria for consultations are met. Now, if you're doing a consultation and you are following the new Medicare consultation rules, then you would bill a 99204. If your carrier still follows the old rules for consultation, you would bill a 99244.
For instance, if the patient is new to you, and he comes in to your office either referred by one of your patients or getting your name from the telephone book or from the medical society and he's – and he basically – he is a new patient, you have not seen him before but he's not a consult, you would still consider him a new patient visit, the 99204. Now, if he is a patient, is an established patient, that you have seen or – face-to-face for some treatment within the past three years, then he would be an established patient, then you would use the code 99214.
The ICD diagnosis for this vasectomy counselling would very nicely be V25.09 which says this is for family planning. Unfortunately, many carriers review – view this code, V25.09, as a female code and will not pay you for a male patient. So you should use both for the vasectomy counselling and the performance of the vasectomy the ICD-9 code V25.2. This is for sterilization, ligation of the vasa. This V-code used as a primary diagnosis will be paid. So you can use this particular V-code as your primary diagnosis and expect the payment for both your counselling visit and for the vasectomy procedure.
Notice that I have used Level IVs for all of the visits. Now, I base that upon the fact –that the medic – in the medical decision making portion of your E/M, the third key component, the medical decision making component, the AUA levels of risks that have been associated and confirmed with the physician's reimbursement services show that a moderate or a Level IV would say, be an acute pyelonephritis, a nodule of a prostate. And another diagnosis or another procedure is the vasectomy procedure would be considered a Level IV in the medical decision making table of risks and also, it's a 90-day global.