The common clinical scenarios concerning male infertility, for instance, azoospermia – no sperm cells seen in the ejaculate, ICD-9 code 606.0. Procedure: scrotal exploration, bilateral testicular sperm aspiration, bilateral open testicular biopsies and bilateral epididymal biopsies. The highest paying code, and the code that should be billed as your primary code, is the 54865 which the bilateral epididymal biopsies.
Your second code would be your bilateral testicular open biopsies and that's 50505 (54505?). You're doing it bilaterally so add modifier -50. And since this is bundled into the 54865 but certainly would indicate a separate definite procedure, add modifier -59. The same holds for the bilateral testicular sperm aspiration code, the 10021. Again, this is bundled into the 54865 but it definitely represents a separate, distinct procedure. So add modifier -59 and bill for this code also.
And here we have the findings. This is obstruction of ejaculatory ducts. The procedure: transurethral ultrasound of the prostate, a transurethral incision of ejaculatory ducts and bilateral open testicular biopsies. Now, we would bill the highest-paying code as our primary code and that's the open testicular biopsy code, 54505, bilateral, adding modifier -50 and the diagnosis is oligospermia, 606.1. And then we have transurethral incision of the ejaculatory ducts, 52402; the diagnosis, obstruction of the ejaculatory ducts, 608.89 and possibly a – you want in these situations often see a prostatic cyst and that would – that diagnosis would be 600.3.
For transrectal ultrasound of the prostate, you would bill 76872, diagnosis, oligospermia, no modifier -26 that indicates that this procedure is being done in a – in a facility, in a hospital and that the physician doing this surgery does not own the x-ray equipment. He is not – he doesn't pay you, let's say, for the radiology technician but he does the professional component. He interprets the radiographic ultrasonic findings so you add indicating the propo – performance of the professional component by adding modifier -26.
In bilateral vasovasotomy, use the operating microscope to reverse a previous vasectomy. And the code for the bilateral vasovasotomy is 55400 modifier -50. The diagnostic code indicating medical necessity is the V26.0. It's a V-code used as a primary code indicating a vasoplasty to reverse a vasectomy. And we use the microscope – the operating microscope – 69990. Notice no modifier -51 and the same diagnosis, vasoplasty. We would later on do a sperm count, 89320, semen analysis looking at volume, looking at mobility, looking at morphology and doing a sperm count. Also, looking for the presence of sperm on an ejaculate, 89321, and the diagnostic code is V26.22, semen analysis performed after a vasovasotomy. That is the medical reason for doing this particular test, the semen analysis.
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