RE: Vasectomy and Post Semen Analysis -- billing

[Guest guest]

,

My previous lab tech would look grossly and if see nothing, then do a spun sample.

Do you just look at a gross sample or do you spin it down to catch every last drop of possible spermies?

Locke, MD

From: [mailto: ] On Behalf Of T. , MDSent: Monday, October 27, 2008 10:35 PMTo: Subject: RE: Vasectomy and Post Semen Analysis -- billing

,

I have always done the semen analysis myself, and I have never charged the patient for it (beyond the total charge for the vasectomy). There is nothing fancy to it. Either you see sperm or you don’t.

dts

From: [mailto: ] On Behalf Of LockeSent: Monday, October 27, 2008 5:48 PMSubject: Vasectomy and Post Semen Analysis -- billing

For those doing vasectomies -- how do you handle the billing of the post vasectomy semen analysis?

1. Don't recommend them

2. Do them -- look at the sample myself in the office

3. Done through the local lab -- but cost absorbed into vasectomy fee

4. Done through the local lab -- but cost billed to the patient's insurance

My understanding is -- the semen analysis is part of the CPT 55250.

http://www.aafp.org/fpm/20031100/coding.html

In the July/August issue, "CPT code for semen analysis" [page 26] indicated that CPT code 89321 should be used for semen analysis post-vasectomy. This is true as long as the vasectomy and semen analysis were not performed by the same entity (e.g., if a family practice office lab does a semen analysis for a patient who received a vasectomy from a urologist across town). When the two services are performed by the same entity, the more appropriate code to use is 55250, "Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)."

The problem I am running into is -- I have been including the semen analysis in the total cost -- and this worked fine when the local lab tech could read them.

But that tech went away and the patients have to go through the hospital now.

The quirk is -- we charge for labs in our office, but the lab in our building is the hospital lab -- who charges us and we charge the patient.

But when the patient goes to the hospital, they screw it up and charge the patient -- so there is lots of monkeying around.

I guess the simple answer is -- since I'm not doing the analysis myself, I should just have them charge it to their insurance.

I was trying to save the patient a little money on the tail end.

For a 89321 Post-Vasectomy Semen Analysis -- the hospital charges the patient/insurance ~$65 -- and charges my office $6.50.

But I guess I should just say from now on -- you do the PVSA through the hospital and get charged through them.

Still curious what other vasectomists are doing.

Locke, MD

[Guest guest]

,

I have always done the semen analysis myself, and I have never

charged the patient for it (beyond the total charge for the vasectomy).

There is nothing fancy to it. Either you see sperm or you don’t.

dts

From:

[mailto: ] On Behalf Of Locke

Sent: Monday, October 27, 2008 5:48 PM

Subject: Vasectomy and Post Semen Analysis --

billing

For those doing vasectomies -- how do you handle the billing

of the post vasectomy semen analysis?

1. Don't recommend them

2. Do them -- look at the sample myself in the office

3. Done through the local lab -- but cost absorbed into

vasectomy fee

4. Done through the local lab -- but cost billed to the

patient's insurance

My understanding is -- the semen analysis is part of the CPT

55250.

http://www.aafp.org/fpm/20031100/coding.html

In the July/August issue, " CPT code for semen

analysis " [page 26] indicated that CPT code 89321 should be used for

semen analysis post-vasectomy. This is true as long as the vasectomy and semen

analysis were not performed by the same entity (e.g., if a family practice

office lab does a semen analysis for a patient who

received a vasectomy from a urologist across town). When the two services are

performed by the same entity, the more appropriate code to use is 55250,

" Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s). "

The problem I am running into is -- I have been including

the semen analysis in the total cost -- and this worked fine when the local lab

tech could read them.

But that tech went away and the patients have to go through

the hospital now.

The quirk is -- we charge for labs in our office, but the

lab in our building is the hospital lab -- who charges us and we charge the

patient.

But when the patient goes to the hospital, they screw it up

and charge the patient -- so there is lots of monkeying around.

I guess the simple answer is -- since I'm not doing the

analysis myself, I should just have them charge it to their insurance.

I was trying to save the patient a little money on the tail

end.

For a 89321 Post-Vasectomy Semen Analysis -- the hospital

charges the patient/insurance ~$65 -- and charges my office $6.50.

But I guess I should just say from now on -- you do the PVSA

through the hospital and get charged through them.

Still curious what other vasectomists are doing.

Locke, MD

[Guest guest]

If you can’t see a single sperm in multiple high powered fields,

then the sperm count is so low that the patient is infertile. I always check

twice, once at 60 days and a second time at 90, to check for “early

recanalization,” though after about 1,000 vasectomies I have never seen that. The

second test does give me peace of mind, that I didn’t miss anything the first

time. I have had a few patients who didn‘t clear till 4 months, though.

dts

From:

[mailto: ] On Behalf Of Locke

Sent: Monday, October 27, 2008 12:20 AM

To:

Subject: RE: Vasectomy and Post Semen Analysis --

billing

,

My previous lab tech would look grossly and if see nothing, then do

a spun sample.

Do you just look at a gross sample or do you spin it down to catch

every last drop of possible spermies?

Locke, MD

From:

[mailto: ] On Behalf Of T.

, MD

Sent: Monday, October 27, 2008 10:35 PM

To:

Subject: RE: Vasectomy and Post Semen Analysis --

billing

,

I have always done the semen analysis

myself, and I have never charged the patient for it (beyond the total charge

for the vasectomy). There is nothing fancy to it. Either you see

sperm or you don’t.

dts

From:

[mailto: ]

On Behalf Of Locke

Sent: Monday, October 27, 2008 5:48 PM

Subject: Vasectomy and Post Semen Analysis --

billing

For

those doing vasectomies -- how do you handle the billing of the post vasectomy

semen analysis?

1.

Don't recommend them

2.

Do them -- look at the sample myself in the office

3.

Done through the local lab -- but cost absorbed into vasectomy fee

4.

Done through the local lab -- but cost billed to the patient's insurance

My

understanding is -- the semen analysis is part of the CPT 55250.

http://www.aafp.org/fpm/20031100/coding.html

In

the July/August issue, " CPT

code for semen analysis " [page 26] indicated that CPT code 89321

should be used for semen analysis post-vasectomy. This is true as long as the

vasectomy and semen analysis were not performed by the same entity (e.g., if a

family practice office lab does a semen analysis for

a patient who received a vasectomy from a urologist across town). When the two

services are performed by the same entity, the more appropriate code to use is

55250, " Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s). "

The

problem I am running into is -- I have been including the semen analysis in the

total cost -- and this worked fine when the local lab tech could read them.

But

that tech went away and the patients have to go through the hospital now.

The

quirk is -- we charge for labs in our office, but the lab in our building is

the hospital lab -- who charges us and we charge the patient.

But

when the patient goes to the hospital, they screw it up and charge the patient

-- so there is lots of monkeying around.

I

guess the simple answer is -- since I'm not doing the analysis myself, I should

just have them charge it to their insurance.

I

was trying to save the patient a little money on the tail end.

For

a 89321 Post-Vasectomy Semen Analysis -- the hospital charges the

patient/insurance ~$65 -- and charges my office $6.50.

But

I guess I should just say from now on -- you do the PVSA through the hospital

and get charged through them.

Still

curious what other vasectomists are doing.

Locke, MD

[Guest guest]

If you can’t see a single sperm in multiple high powered fields,

then the sperm count is so low that the patient is infertile. I always check

twice, once at 60 days and a second time at 90, to check for “early

recanalization,” though after about 1,000 vasectomies I have never seen that. The

second test does give me peace of mind, that I didn’t miss anything the first

time. I have had a few patients who didn‘t clear till 4 months, though.

dts

From:

[mailto: ] On Behalf Of Locke

Sent: Monday, October 27, 2008 12:20 AM

To:

Subject: RE: Vasectomy and Post Semen Analysis --

billing

,

My previous lab tech would look grossly and if see nothing, then do

a spun sample.

Do you just look at a gross sample or do you spin it down to catch

every last drop of possible spermies?

Locke, MD

From:

[mailto: ] On Behalf Of T.

, MD

Sent: Monday, October 27, 2008 10:35 PM

To:

Subject: RE: Vasectomy and Post Semen Analysis --

billing

,

I have always done the semen analysis

myself, and I have never charged the patient for it (beyond the total charge

for the vasectomy). There is nothing fancy to it. Either you see

sperm or you don’t.

dts

From:

[mailto: ]

On Behalf Of Locke

Sent: Monday, October 27, 2008 5:48 PM

Subject: Vasectomy and Post Semen Analysis --

billing

For

those doing vasectomies -- how do you handle the billing of the post vasectomy

semen analysis?

1.

Don't recommend them

2.

Do them -- look at the sample myself in the office

3.

Done through the local lab -- but cost absorbed into vasectomy fee

4.

Done through the local lab -- but cost billed to the patient's insurance

My

understanding is -- the semen analysis is part of the CPT 55250.

http://www.aafp.org/fpm/20031100/coding.html

In

the July/August issue, " CPT

code for semen analysis " [page 26] indicated that CPT code 89321

should be used for semen analysis post-vasectomy. This is true as long as the

vasectomy and semen analysis were not performed by the same entity (e.g., if a

family practice office lab does a semen analysis for

a patient who received a vasectomy from a urologist across town). When the two

services are performed by the same entity, the more appropriate code to use is

55250, " Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s). "

The

problem I am running into is -- I have been including the semen analysis in the

total cost -- and this worked fine when the local lab tech could read them.

But

that tech went away and the patients have to go through the hospital now.

The

quirk is -- we charge for labs in our office, but the lab in our building is

the hospital lab -- who charges us and we charge the patient.

But

when the patient goes to the hospital, they screw it up and charge the patient

-- so there is lots of monkeying around.

I

guess the simple answer is -- since I'm not doing the analysis myself, I should

just have them charge it to their insurance.

I

was trying to save the patient a little money on the tail end.

For

a 89321 Post-Vasectomy Semen Analysis -- the hospital charges the

patient/insurance ~$65 -- and charges my office $6.50.

But

I guess I should just say from now on -- you do the PVSA through the hospital

and get charged through them.

Still

curious what other vasectomists are doing.

Locke, MD

[Guest guest]

If you can’t see a single sperm in multiple high powered fields,

then the sperm count is so low that the patient is infertile. I always check

twice, once at 60 days and a second time at 90, to check for “early

recanalization,” though after about 1,000 vasectomies I have never seen that. The

second test does give me peace of mind, that I didn’t miss anything the first

time. I have had a few patients who didn‘t clear till 4 months, though.

dts

From:

[mailto: ] On Behalf Of Locke

Sent: Monday, October 27, 2008 12:20 AM

To:

Subject: RE: Vasectomy and Post Semen Analysis --

billing

,

My previous lab tech would look grossly and if see nothing, then do

a spun sample.

Do you just look at a gross sample or do you spin it down to catch

every last drop of possible spermies?

Locke, MD

From:

[mailto: ] On Behalf Of T.

, MD

Sent: Monday, October 27, 2008 10:35 PM

To:

Subject: RE: Vasectomy and Post Semen Analysis --

billing

,

I have always done the semen analysis

myself, and I have never charged the patient for it (beyond the total charge

for the vasectomy). There is nothing fancy to it. Either you see

sperm or you don’t.

dts

From:

[mailto: ]

On Behalf Of Locke

Sent: Monday, October 27, 2008 5:48 PM

Subject: Vasectomy and Post Semen Analysis --

billing

For

those doing vasectomies -- how do you handle the billing of the post vasectomy

semen analysis?

1.

Don't recommend them

2.

Do them -- look at the sample myself in the office

3.

Done through the local lab -- but cost absorbed into vasectomy fee

4.

Done through the local lab -- but cost billed to the patient's insurance

My

understanding is -- the semen analysis is part of the CPT 55250.

http://www.aafp.org/fpm/20031100/coding.html

In

the July/August issue, " CPT

code for semen analysis " [page 26] indicated that CPT code 89321

should be used for semen analysis post-vasectomy. This is true as long as the

vasectomy and semen analysis were not performed by the same entity (e.g., if a

family practice office lab does a semen analysis for

a patient who received a vasectomy from a urologist across town). When the two

services are performed by the same entity, the more appropriate code to use is

55250, " Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s). "

The

problem I am running into is -- I have been including the semen analysis in the

total cost -- and this worked fine when the local lab tech could read them.

But

that tech went away and the patients have to go through the hospital now.

The

quirk is -- we charge for labs in our office, but the lab in our building is

the hospital lab -- who charges us and we charge the patient.

But

when the patient goes to the hospital, they screw it up and charge the patient

-- so there is lots of monkeying around.

I

guess the simple answer is -- since I'm not doing the analysis myself, I should

just have them charge it to their insurance.

I

was trying to save the patient a little money on the tail end.

For

a 89321 Post-Vasectomy Semen Analysis -- the hospital charges the

patient/insurance ~$65 -- and charges my office $6.50.

But

I guess I should just say from now on -- you do the PVSA through the hospital

and get charged through them.

Still

curious what other vasectomists are doing.

Locke, MD