Urology Reimbursement: Coding for MESA, TESA

December 16, 2009

Question: Could you please give me the most current coding guidelines for the MESA and TESA procedures? The last I was aware, we were to use unlisted procedure codes. Is that still correct?

Answer: You should still use unlisted procedure codes to report microsurgical epididymal sperm aspiration (MESA) and testicular sperm aspiration (TESA, sometimes called TESE for testicular sperm extraction).

There are no Category I procedure codes for these procedures. For MESA, however, there is an S code: S4028 (Microsurgical epididymal sperm aspiration).

Bad news: Unfortunately, not all payers, including Medicare, will pay for S4028. S codes, found in the HCPCS manual, are temporary national codes for which Medicare will not reimburse you. You may typically report S codes to some private payers and Medicaid, but doublecheck the rules for your particular state and payer.

For payers that do not recognize S codes, you should report the unlisted procedure code, 55899 (Unlisted procedure, male genital system), for MESA. You should also use this unlisted code for all payers when reporting TESA/TESE.

Charge the patient: Many payers will not pay for male infertility diagnostic procedures or treatments, including MESA and TESA/TESE diagnostic procedures. Check with the patient’s insurance before the urologist performs the infertility service, and remember to request and obtain precertification from the payer before the procedure. You should also obtain a signed advance beneficiary notice (ABN) from the patient if you expect the payer to deny payment.

Remember: ABNs help patients decide whether they want to proceed with a service even though they may have to pay for it. A signed ABN helps ensure that your office will receive payment directly from the patient if a carrier refuses to pay. Without a valid ABN, you cannot hold a Medicare beneficiary responsible for the denied charges.

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Thursday on AUDIO: Dr. Ferragamo’s 2010 Coding & Reimbursement Update.

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