Vasectomy

2026 Medicare PFS: 3.29 wRVU · 90-day global
wRVU3.29
Global90-day
ApproachOpen
ComplexityModerate
Procedure:

Bilateral no-scalpel vasectomy with mucosal cautery and fascial interposition

Indication:

Desires permanent contraception.

Consent:

Informed consent was obtained after discussion of the procedure as permanent contraception, the need for other contraception until semen analysis confirms clearance, and the risks, including bleeding, hematoma, infection, chronic scrotal pain, and early or late failure, as well as benefits and alternatives.

Performed By:

[***, MD/DO]

Anesthesia:

Local: [X] mL of [1% / 2%] lidocaine without epinephrine, perivasal block

Findings:

A single vas deferens was identified and divided on each side. Scrotal contents were [normal / ***] on palpation.

Description of Procedure:

A time-out was completed confirming the patient and procedure. The scrotum was prepped with [povidone-iodine / chlorhexidine] and draped. Using the three-finger technique, the right vas deferens was isolated beneath the median raphe, and a skin wheal and perivasal block were placed with [X] mL of [1% / 2%] lidocaine without epinephrine. The left perivasal block was placed through the same skin wheal.

The right vas was fixed through the skin with the ring clamp. The sharpened curved vas dissector was used to puncture the skin and vas sheath, the opening was spread, and the vas was delivered and stripped of its sheath and vessels. The vas was divided. [A 1-cm segment was excised.] The mucosa of both lumens was cauterized. Fascial interposition was performed by closing the vas sheath over the [abdominal / testicular] end with [a clip / a suture]. Hemostasis was confirmed, and the ends were returned to the scrotum.

The left vas was isolated with the three-finger technique, delivered through the same puncture, and divided, cauterized, and interposed in the same manner. Hemostasis was confirmed. The puncture was [left open / closed with a single absorbable suture], and gauze and a scrotal support were applied.

Specimens:

[Vas segments discarded / Vas segments sent to pathology]

Complications:

None

Post-Procedure Plan:

The patient tolerated the procedure well. He will use scrotal support and ice and avoid strenuous activity, heavy lifting, and sexual activity for [X] days. He will use other contraception until a post-vasectomy semen analysis at 8 to 16 weeks shows azoospermia or rare nonmotile sperm (no more than 100,000/mL). Return precautions for scrotal swelling, fever, or wound drainage were reviewed.

Epic SmartPhrase Version 
PROCEDURE: Bilateral no-scalpel vasectomy with mucosal cautery and fascial interposition
INDICATION: Desires permanent contraception.
CONSENT: Informed consent obtained after discussion of permanence, need for other contraception until semen analysis confirms clearance, risks (bleeding, hematoma, infection, chronic scrotal pain, early or late failure), benefits, and alternatives.
PERFORMED BY: ***, MD/DO
ANESTHESIA: Local: *** mL [1% / 2%] lidocaine without epinephrine, perivasal block

FINDINGS: Single vas identified and divided on each side. Scrotal contents [normal / ***] on palpation.

PROCEDURE DETAILS:
Time-out completed. Scrotum prepped with [povidone-iodine / chlorhexidine] and draped. Three-finger technique, right vas isolated beneath the median raphe. Skin wheal and bilateral perivasal blocks, *** mL [1% / 2%] lidocaine without epinephrine. Right vas fixed with ring clamp, skin and vas sheath punctured with vas dissector, vas delivered and stripped. Vas divided[, 1-cm segment excised]. Mucosa of both lumens cauterized. Sheath closed over the [abdominal / testicular] end with [a clip / a suture]. Hemostasis confirmed, ends returned. Left vas delivered through the same puncture and treated identically. Puncture [left open / closed with a single absorbable suture]. Gauze and scrotal support applied.

SPECIMENS: [Vas segments discarded / Vas segments sent to pathology]
COMPLICATIONS: None
POST-PROCEDURE PLAN: Tolerated well. Scrotal support and ice. No strenuous activity, heavy lifting, or sexual activity for *** days. Other contraception until post-vasectomy semen analysis at 8 to 16 weeks shows azoospermia or rare nonmotile sperm (no more than 100,000/mL). Return precautions reviewed.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Conventional (Scalpel Incision) Vasectomy

A [1-cm] [midline scrotal / right hemiscrotal] incision was made over the right vas, which was grasped with an Allis clamp, delivered, and dissected free of its sheath and vessels. The vas was divided. [A 1-cm segment was excised.] The mucosa of both lumens was cauterized, and the vas sheath was closed over the abdominal end with [a clip / a suture]. Hemostasis was confirmed, and the ends were returned to the scrotum. The left vas was delivered through [the same incision / a separate left hemiscrotal incision] and treated in the same manner. The skin was closed with [4-0 chromic] suture.

Charting Tips
  1. Name the occlusion method. Mucosal cautery with or without fascial interposition, and open-ended vasectomy with cautery and interposition of the abdominal end, have the lowest failure rates. Ligation or clips alone without cautery or interposition fail more often.
  2. Post-vasectomy semen analysis is done at 8 to 16 weeks. Clearance is azoospermia or rare nonmotile sperm (no more than 100,000/mL). Any motile sperm at 6 months is a failure and warrants repeat vasectomy.
  3. Vasectomy is not immediately effective. Document counseling to use other contraception until the semen analysis confirms clearance, and that the patient understands the procedure is permanent.
  4. Sending vas segments to pathology is optional. If segments are discarded, the description should state that each vas was identified, delivered, and divided.
Documentation & Reimbursement Considerations
  1. Primary service: Report Vasectomy as the primary service when it is the definitive operation performed.
  2. Vasectomy (3.29 wRVU) is bilateral by definition, so do not append the bilateral modifier or bill twice. No-scalpel and conventional techniques use the same code.
  3. Global period is 90 days (major). Post-vasectomy semen analysis, wound checks, and hematoma management within 90 days are bundled into the global fee.
  4. Vasectomy for contraception is typically not covered by Medicare, but most commercial insurers cover it. Verify the patient's insurance benefits before the procedure.
  5. Sperm banking performed at a separate facility is not billed by the surgeon. Document whether sperm banking was discussed and declined.

ⓘ General Documentation & Reimbursement Considerations →