How To Use CPT Code 55200

CPT 55200 describes the procedure of vasotomy, which involves the insertion of a tube into the vas deferens to check for blockages that may affect fertility. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 55200?

CPT 55200 is used to describe the procedure of vasotomy, which is the insertion of a tube into the vas deferens to ensure there are no blockages that could impair fertility. This code is used when the provider performs the procedure on one or both sides of the vas deferens.

2. Official Description

The official description of CPT code 55200 is: ‘Vasotomy, cannulization with or without incision of vas, unilateral or bilateral (separate procedure).’ This code specifically refers to the insertion of a tube into the vas deferens to check for blockages, with or without making an incision in the vas deferens.

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. An incision is made in the scrotum to access the vas deferens.
3. The surrounding structures are dissected to reach the vas deferens.
4. The provider punctures the vas using a needle and inserts a cannula, or tube, to check for any blockages.
5. If necessary, the provider may make an incision in the vas to allow for the free passage of the cannula.
6. Any incisions made in the vas are repaired.
7. The area is irrigated, checked for bleeding, and any instruments are removed.
8. The incision in the scrotum is closed in layers.

4. Qualifying circumstances

CPT 55200 is performed on patients who require a vasotomy to check for blockages in the vas deferens that may affect fertility. The procedure can be performed unilaterally or bilaterally, depending on the patient’s specific needs. It is important to note that CPT 55200 should not be reported if it is performed as part of a larger, related service.

5. When to use CPT code 55200

CPT code 55200 should be used when the provider performs a vasotomy procedure to check for blockages in the vas deferens. It is important to ensure that the procedure is not reported if it is performed as part of another related service.

6. Documentation requirements

To support a claim for CPT 55200, the provider must document the following information:

• Patient’s diagnosis and the need for a vasotomy procedure
• Details of the procedure performed, including whether it was unilateral or bilateral
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 55200, ensure that the procedure is performed as a separate procedure and not as part of a larger, related service. It is important to follow the specific guidelines and coding instructions provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT 55200 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 urologist performing a vasotomy procedure on a patient to check for blockages in the vas deferens.
2. A reproductive endocrinologist performing a bilateral vasotomy procedure to ensure both vas deferens are free of blockages.
3. A general surgeon performing a unilateral vasotomy procedure on a patient with suspected blockage in one vas deferens.
4. A fertility specialist performing a vasotomy procedure on a patient as part of a larger fertility treatment plan.
5. An interventional radiologist performing a vasotomy procedure on a patient with a history of vasectomy to check for successful reversal.
6. A urologist performing a vasotomy procedure on a patient prior to in vitro fertilization (IVF) treatment.
7. A reproductive endocrinologist performing a bilateral vasotomy procedure on a patient with a history of infertility.
8. A general surgeon performing a unilateral vasotomy procedure on a patient with a suspected blockage in one vas deferens.
9. A fertility specialist performing a vasotomy procedure on a patient as part of a diagnostic workup for infertility.
10. An interventional radiologist performing a vasotomy procedure on a patient with a history of vasectomy to assess the feasibility of vasectomy reversal.