Coding for Microsurgical Techniques in Male Infertility

When coding for microsurgical surgery for infertility the code for microscope use code +69990. As you can see there's a plus sign in front of this number, it appears in the CPT manual. Do not use the plus sign when you are putting this code in your form for payment. The plus sign calls to the attention that this is an add-on code meaning that you cannot bill it alone, it does not need modifier -51, do not add modifier -51. And do not reduce the fee.

In another diagnostic procedure, we have the code 93975, Duplex Doppler study of the varicocele. So duplex scan of arterial inflow and venous out-flow of the scrotal contents. It includes performance, supervision, imaging, hard copy, documentation, interpretation and analysis of the bidirectional flow, all documented and all should be documented in the medical record. Now, if you use a simple hand-held device in your office when you are evaluating a patient with a varicocele, the use of this hand-held device is included in the E/M service and your physical examination. If you use this hand-held device in the operating room while you're doing your varicocelectomy or helping you – helping you diagnose at surgery the varicocele, this also – it becomes a part of the varicocelectomy and this hand-held device used is not a separate billable code.

Let's look at some other surgical diagnostic procedures. We have the code 52402. This is not only diagnostic but it is also therapeutic. This is the cystourethroscopy with transurethral resection or incision of the ejaculatory ducts. We also have the code epididymovasostomy, unilateral or bilateral, 54901 and these procedures are also for reversal of a vasectomy.

These latter two procedures would certainly be used along with the operating microscope and you should also bill the add-on code, 69990, remember without modifier -51 and do not reduce the fee for this service. Another code occasionally performed is the 55300, a vasotomy for vasograms, seminal vesiculograms or an epididymogram. And it would be either unilateral or bilateral. Now, for radiological supervision and interpretation, in other words, interpreting these films, the vasograms or the seminal vesiculogram or the epididymogram, use the code 74440 modifier -26.
Now, you can combine this with testicular biopsy, the open procedure, 54505 or the needle biopsy of the testicles, 54500. Neither of the latter two is bundled into the 55300.

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