Wondering how to bill for Failed Vasectomy and Sperm granuloma? Help is here. Findings: persistent sperm seen in the semen specimen four months after a vasectomy with the left vasal mass palpable is a sperm granuloma. Procedure: repeat bilateral vasectomy and excision of the sperm granuloma.
In case of sperm granuloma, we will bill for both—the excision of a lesion of the spermatic cord, the sperm granuloma, 55520 LT, and we will bill for the vasectomy, the 55250, again with the diagnosis of V25.2.
Here are few examples of unilateral vasectomy. In clinical scenario where an office unilateral vasectomy is followed by a hospital unilateral opposite side vasectomy, the patient had a left vasectomy but had so much pain and discomfort that the physician could not go ahead and do the right vasectomy. He schedules the patient going to the hospital in two weeks and he does the right vasectomy without any problem but using general anesthesia.
On day 1, we will bill for the left vasectomy, 55250, in the office. And then on day 14, we'll bill again for the right vasectomy as a staged procedure, -58 modifier, in the hospital. Notice that a numbered modifier, -58, always goes before the (right?) modifier. Now, for full payment, a detailed documentation should be included in the medical record. And the medical records may be requested by the carrier before they make payment. But because the code description for vasectomy says unilateral or bilateral, on day 1 we did a unilateral vasectomy and on day 14 we did a unilateral vasectomy on the other side.
On day 1, you will be paid for the full amount for the vasectomy. On day 4 you will be paid the full amount which would be less than what the vasectomy was in the office because you're now doing it in the hospital.
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