Simplifying Male Infertility Coding

In male infertility, coding for various semen analyses is tricky. For instance, when using code 89300 for semen analysis, we look for the motility of sperm. And this also includes a Huhner test which is a post coital test of the female after intercourse and ejaculation into the vagina. We have 89310 in which a smear is looked at for motility and a count is made, not including the Huhner test. And then we have the code 89320 – which includes examination of the volume of the semen, the sperm count, the motility and the morphological studies. This is the code one would use most often for an in-office semen analysis.

We have another code 89321, which is for sperm presence and motility. And this refers to looking at a smear of the ejaculate and seeing if sperm are present and are they motile. There is another semen analysis, 89322 in which we measure the volume of the ejaculate, sperm count, motility and the morphology of the sperm using strict morphological criteria. This is known as the Kruger test. And then we have another sperm analysis code 89331. This is sperm evaluation in the patient that has retrograde ejaculation. We are looking at the urine and doing a sperm concentration, motility and morphological study of the sperm that we see in the urine. We may also bill concurrently a semen analysis.


Now, the code 608.87 is the code for retrograde ejaculation. Retrograde ejaculation is the back-wood ejaculation of sperm into the bladder rather than the urethra to exit at the external urethral meatus. This retrograde ejaculation occurs with an incompetent bladder neck which does not close at the time of ejaculation. These retrograde ejaculations can occur following a transurethral resection of the prostate or a transurethral resection of the bladder neck. Incompetent neurological enervation of the bladder neck as seen in some patients with diabetes mellitus and multiple sclerosis also may result in retrograde ejaculation. Now if you just look at the urine voided after an ejaculation, just to look and see if there is sperm present in the urine, the coding for that should be 81015.

When it comes to male infertility surgical procedures, the most common one are the testicular biopsies. We have a code, 54500; this is biopsy of the testicle, needle biopsy, a separate procedure. And if you do it bilaterally, you would add a -50 modifier to the 54500. This has a zero day global. And this needle biopsy can be performed percutaneously or through an open incisional approach. Now, we then have fine needle aspiration of the testicles. We have 10021 which is a fine needle aspiration without image guidance. And we have a 10022 with image guidance. These two codes, these two types of needle aspirations can also be performed either percutaneously or via an open approach directly into the testicle. These codes are billed either for unilateral or bilateral aspirations. Now, for radiological supervision as would be used in the 10022 and interpretation, use the 76942 which is ultrasound guidance. And that's the one you would use probably most likely or fluoroscopic guidance which would probably not be as frequently as used, 77002, or a CT, 77012, or MRI guidance, 77021. Now, when you obtain the needle aspirants with the fine needle, for evaluation of the fine needle aspiration, you can bill the code 88172 and 88173. The 88172 is looking at the cytopathology, this is an immediate study after the aspiration to determine the adequacy of your specimen to use for diagnosis. You can bill each site and you can repeat the aspirations. Now, if you do this and then you also write up in a report with your interpretation, you could bill the 88173. And here, we have the code for testicular biopsy, 54505, biopsy of the testicle in incisional, meaning that you've opened up the scrotal sack, opened up the tunica vaginalis and you've looked at the testicle and do a small incision into the tunica albuginea and then take a small segment of the spermatic tubules that herniate through the small incision. For bilateral biopsies, add modifier -50, it's a zero day global and there again, is no payment for an assistant if one is used.

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