How To Use CPT Code 54900

CPT 54900 describes the surgical procedure known as epididymovasostomy, which involves the connection of the epididymis to the vas deferens. This article will provide an overview of CPT code 54900, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 54900?

CPT 54900 is used to describe the surgical procedure in which the provider connects the epididymis to the vas deferens. This procedure is performed to correct a blockage of sperm flow from the epididymis to the vas deferens. It is important to note that CPT 54900 is specific to a unilateral procedure, meaning it is performed on one side only.

2. Official Description

The official description of CPT code 54900 is: ‘Epididymovasostomy, anastomosis of epididymis to vas deferens; unilateral.’

3. Procedure

1. The provider begins by making an incision in the scrotum and accessing the testis with the epididymis.
2. Next, the provider explores and removes the vas deferens.
3. The provider then opens the affected area of the epididymis.
4. Using sutures, the provider connects the opened epididymal tubule to the excised end of the vas deferens, reinforcing the connection with additional sutures.
5. A drain is placed in the scrotum, and the incision is closed.

4. Qualifying circumstances

CPT 54900 is performed on patients who have a blockage in the epididymis that prevents the flow of sperm to the vas deferens. This procedure is typically indicated when other less invasive treatments have failed to resolve the blockage. It is important to note that CPT 54900 is specific to a unilateral procedure, meaning it is performed on one side only.

5. When to use CPT code 54900

CPT code 54900 should be used when the provider performs the epididymovasostomy procedure to connect the epididymis to the vas deferens on one side. It is important to ensure that the procedure is performed on the correct side and that it is medically necessary due to a blockage in the epididymis.

6. Documentation requirements

To support a claim for CPT 54900, the provider must document the following information:

• The patient’s diagnosis and the presence of a blockage in the epididymis
• The specific details of the procedure, including the incision, exploration, removal of the vas deferens, connection of the epididymal tubule to the vas deferens, and closure of the incision
• The date of the procedure
• Any additional relevant information, such as the use of a drain or any complications encountered
• The provider’s signature

7. Billing guidelines

When billing for CPT 54900, it is important to ensure that the procedure is performed on one side only. Additionally, it is crucial to follow any specific guidelines provided by the payer regarding documentation and medical necessity. It is also important to review any bundling or unbundling rules that may apply to CPT 54900.

8. Historical information

CPT 54900 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes a unilateral epididymovasostomy to correct a blockage in the epididymis on the left side.
2. A provider performs a unilateral epididymovasostomy to restore sperm flow in a patient with a previous vasectomy on the right side.
3. A patient with a unilateral blockage in the epididymis undergoes an epididymovasostomy to improve fertility.
4. A provider performs a unilateral epididymovasostomy to address a blockage in the epididymis caused by a previous infection.
5. A patient with a unilateral blockage in the epididymis undergoes an epididymovasostomy to increase the chances of successful conception.
6. A provider performs a unilateral epididymovasostomy to restore sperm flow in a patient with a congenital blockage in the epididymis.
7. A patient undergoes a unilateral epididymovasostomy to address a blockage in the epididymis caused by trauma.
8. A provider performs a unilateral epididymovasostomy to improve sperm quality and motility in a patient with a unilateral blockage in the epididymis.
9. A patient with a unilateral blockage in the epididymis undergoes an epididymovasostomy to increase the chances of successful natural conception.
10. A provider performs a unilateral epididymovasostomy to address a blockage in the epididymis caused by a previous surgical procedure.