CPT® Code 55200

1. Indications

The vasotomy procedure, coded as CPT® 55200, is indicated for various clinical scenarios where examination of the vas deferens is necessary. The following conditions may warrant this procedure:

• Infertility Evaluation: When assessing male infertility, a vasotomy may be performed to analyze the presence and quality of sperm in the vas deferens.
• Obstruction Investigation: This procedure can help identify any obstructions within the vas deferens that may be contributing to infertility or other reproductive issues.
• Fluid Analysis: The aspiration of fluid from the vas deferens allows for microscopic examination, which can provide valuable information regarding the reproductive health of the patient.

2. Procedure

The vasotomy procedure involves several detailed steps, which can vary depending on whether an incision is made or not. The following outlines the procedural steps for both approaches:

• Step 1: Preparation and Anesthesia The patient is positioned appropriately, and local anesthesia is administered to ensure comfort during the procedure. The scrotum is then palpated to locate the vas deferens.
• Step 2: Incision Approach For a vasotomy with incision, a small incision is made in the skin over the identified vas deferens. The vas is carefully pulled up into the operative field, and a straight clamp is placed beneath it.
• Step 3: Hemi-Vasotomy Incision Utilizing an operative microscope and a micro-knife, a hemi-vasotomy incision is created. The clamp serves as a stable platform for this incision, allowing for precision.
• Step 4: Fluid Collection Fluid is obtained from the opening of the vas deferens. This fluid can be examined immediately in the operating room or sent to a laboratory for further analysis as a separately reportable procedure.
• Step 5: Cannulization An angiocath is inserted into the distal end of the vasotomy to cannulize the vas deferens. Additional fluid samples are collected for examination or laboratory analysis.
• Step 6: Closure After fluid collection, the angiocath is removed, and the hemi-vasotomy is closed in layers. The skin incision is then sutured closed.
• Step 7: Repeat for Bilateral Examination If both the right and left vas deferens are to be examined, the entire procedure is repeated on the opposite side.
• Step 8: Non-Incision Approach In cases where the vasotomy is performed without incision, the scrotum is palpated to locate a straight portion of the vas deferens. An angiocath or lymphangiogram needle is carefully threaded into the vasal lumen to aspirate fluid.
• Step 9: Fluid Aspiration The aspirated fluid is examined microscopically or sent to the laboratory for analysis. After aspiration, the needle is withdrawn, and firm pressure is applied to the puncture site to minimize bleeding.
• Step 10: Repeat for Bilateral Examination Similar to the incision approach, if both sides are to be examined, the procedure is repeated on the opposite side.

3. Post-Procedure

Post-procedure care for a vasotomy includes monitoring the patient for any signs of complications such as bleeding or infection at the incision or puncture site. Patients are typically advised to apply firm pressure to the area to minimize bleeding and to avoid strenuous activities for a specified period to promote healing. Follow-up appointments may be scheduled to discuss the results of the fluid analysis and to determine any further necessary interventions based on the findings. It is essential for patients to adhere to any specific post-operative instructions provided by their healthcare provider to ensure optimal recovery.