CurrentSouth Carolina Department of Health and Human ServicesPolicy N/A
SECTION 4 Procedure Codes — Procedure codes requiring supporting documentation and assistant surgeon payment categories
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Lists procedure codes (ICD-10-PCS and CPT/HCPCS) that require supporting documentation or prior authorization and describes assistant surgeon payment categories; applies to SCDHHS claims review and Quality Improvement Organization (QIO) review processes.
Policy Summary
PayerSouth Carolina Department of Health and Human Services
PolicySECTION 4 Procedure Codes — Procedure codes requiring supporting documentation and assistant surgeon payment categories
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateN/A
Next Review DateN/A
Key ActionInclude supporting documentation with claims for listed ICD-10-PCS procedure codes for QIO review.
SourceLink
POLICY UPDATE CHANGES
No material clinical or coverage changes in this revision.
Multipleprocedure codes requiring supporting documentation
20+distinct ICD-10-PCS codes shown or repeated
1supporting documentation requirement
multipleapproach variants listed
examplesexample procedures noted
Coverage criteria and documentation requirements
Documentation and payment category criteria
Certain ICD-10-PCS surgical procedure codes listed in Section 4 require submission of supporting documentation for review by SCDHHS's Quality Improvement Organization (QIO). Assistant surgeon payment category codes are noted in the payment category section.
ICD-10-PCS codes listed under 'ICD-10-PCS SURGICAL CODES AND PROCEDURE CODES REQUIRING SUPPORTING DOCUMENTATION' must be submitted with supporting documentation for QIO review.
Payment Category descriptors (shown in the Payment Category section) identify assistant surgeon payment categories applicable to claims; providers should apply the two‑digit payment category codes as listed when billing.
Coverage stance for listed procedure codes
The document provides code listings for occlusion of the vas deferens with intraluminal devices; no explicit coverage criteria, medical necessity rules, or authorization instructions are stated in this excerpt.
ICD-10-PCS procedure codes for occlusion of vas deferens with intraluminal device are listed (e.g., 0VLN4DZ, 0VLN8DZ, 0VLP0DZ, 0VLP3DZ, 0VLP4DZ, 0VLP8DZ, 0VLQ0DZ).
No coverage limitations, explicit medical necessity criteria, or prior authorization requirements are provided in this excerpt for these codes.
Coverage stance — informational code list
This extract is an informational code listing for occlusion of vas deferens and release of epididymis; it does not state coverage determinations or clinical criteria.
Procedure codes shown include bilateral and unilateral occlusion codes (0VLQ0DZ, 0VLQ3DZ, 0VLQ4DZ, 0VLQ8DZ) and epididymis release codes (0VNJ0ZZ, 0VNJ3ZZ, 0VNJ4ZZ).
No explicit coverage decisions, medical necessity rules, or exclusions are provided in these lines.
Coverage notes for listed procedure codes
Some procedure codes appear under the heading 'Procedure Codes Requiring Supporting Documentation'; providers should include supporting documentation when billing these codes.
Supporting documentation: Codes listed under the heading 'Procedure Codes Requiring Supporting Documentation' require supporting documentation to be submitted for QIO review when billed.
Code examples: Examples of ICD-10-PCS codes referenced in this section include 0VNK8ZZ, 0VNL0ZZ and related epididymis release codes; the listings map codes to short descriptions indicating procedure and approach.
Procedure code listing — no criteria in excerpt
Section 4 provides multiple ICD-10-PCS repair procedure code listings (spermatic cord and epididymis repairs); the excerpt does not include coverage criteria or medical necessity statements.
ICD-10-PCS repair codes for bilateral spermatic cord and right epididymis repair are listed (e.g., 0VQH0ZZ, 0VQH3ZZ, 0VQH4ZZ, 0VQH8ZZ, 0VQJ0ZZ, 0VQJ3ZZ, 0VQJ4ZZ).
No explicit coverage, prior authorization, or medical necessity criteria are provided in this excerpt.
Procedure code listing
Procedure code list lines enumerate repair codes for spermatic cords and epididymis across approaches; no coverage conditions are specified here.
Listed codes include open, percutaneous, percutaneous endoscopic, and via natural/artificial opening endoscopic approaches (e.g., 0VQH3ZZ, 0VQH4ZZ, 0VQH8ZZ, 0VQJ0ZZ, 0VQJ3ZZ, 0VQJ4ZZ, 0VQJ8ZZ, 0VQK0ZZ, 0VQK3ZZ).
This excerpt contains code listings only and does not state coverage limitations or medical necessity rules.
Procedure code reference (Section 4, partial)
Partial reference list of ICD-10-PCS repair procedure codes for epididymis and spermatic cords; repetitive code lines appear without coverage decision language.
Codes shown include repair-right/left/bilateral epididymis and spermatic cord repair variants across approaches (examples: 0VQJ4ZZ, 0VQJ8ZZ, 0VQK0ZZ, 0VQK3ZZ, 0VQH4ZZ, 0VQH8ZZ).
No explicit coverage determinations, authorization requirements, or clinical criteria are provided in this partial reference listing.
Procedure code listing — no criteria provided
Section 4 contains code entries for repair of epididymis and spermatic cords; the excerpt does not present coverage conditions or medical necessity guidance.
ICD-10-PCS procedure codes listed include 0VQJ0ZZ, 0VQJ3ZZ, 0VQJ4ZZ, 0VQJ8ZZ, 0VQK0ZZ, 0VQK3ZZ, 0VQK4ZZ, 0VQK8ZZ, 0VQH8ZZ—mapped to short descriptors for approach and laterality.
No coverage criteria, explicit authorizations, or exclusions are included in this excerpt.
Procedure codes — informational
Additional procedure code listings for epididymis repair appear with repeated approach qualifiers; these lines provide coding information only, not coverage rules.
Codes listed include right and left epididymis repair variants and approach qualifiers (e.g., 0VQJ3ZZ, 0VQJ4ZZ, 0VQJ8ZZ, 0VQK0ZZ, 0VQK3ZZ, 0VQK4ZZ, 0VQK8ZZ).
The excerpt contains informational code listings without medical necessity or prior authorization instructions.
ICD-10-PCS procedure code groups
Sample ICD-10-PCS surgical codes requiring documentationICD-10Covered
| 00Q00ZZ | REPAIR BRAIN, OPEN APPROACH |
| 00Q03ZZ | REPAIR BRAIN, PERCUTANEOUS APPROACH |
| 00Q04ZZ | REPAIR BRAIN, PERCUTANEOUS ENDOSCOPIC APPROACH |
| 08SN0ZZ | REPOSITION RIGHT UPPER EYELID, OPEN APPROACH |
| 08SN3ZZ | REPOSITION RIGHT UPPER EYELID, PERCUTANEOUS APPROACH |
| 08SP0ZZ | REPOSITION LEFT UPPER EYELID, OPEN APPROACH |
| 08SP3ZZ | REPOSITION LEFT UPPER EYELID, PERCUTANEOUS APPROACH |
Gastric bypass and related ICD-10-PCS codesICD-10Covered
| 0D16079 | BYPASS STOMACH TO DUODENUM WITH AUTOLOGOUS TISSUE, OPEN APPROACH |
| 0D1607B | BYPASS STOMACH TO ILEUM WITH AUTOL SUB, OPEN APPROACH |
| 0D1607L | BYPASS STOMACH TO TRANS COLON WITH AUTOL SUB, OPEN APPROACH |
| 0D160J9 | BYPASS STOMACH TO DUODENUM WITH SYNTH SUB, OPEN APPROACH |
| 0D160JB | BYPASS STOMACH TO ILEUM WITH SYNTH SUB, OPEN APPROACH |
| 0D160JL | BYPASS STOMACH TO TRANSVERSE COLON WITH SYNTH SUB, OPEN APPROACH |
ICD-10-PCS procedures mentionedICD-10Covered
| 0D168ZL | Bypass stomach to transverse colon, endo (ICD-10-PCS) / listed in document |
| 0D168ZB | Bypass stomach to ileum, endo (ICD-10-PCS) / listed in document |
| 0VLN0DZ | Occlusion of right vas deferens with intraluminal device, open approach (ICD-10-PCS) / listed |
| 0VLN3DZ | Occlusion of right vas deferens with intraluminal device, percutaneous approach (ICD-10-PCS) / listed |
| 0VLN4DZ | Occlusion right vas deferens with intraluminal device, percutaneous endo (ICD-10-PCS) / listed |
| 0VLN8DZ | Occlusion of right vas deferens with intraluminal device via natural or artificial opening endoscopic (ICD-10-PCS) / listed |
| 0VLP0DZ | Occlusion of left vas deferens with intraluminal device, open approach (ICD-10-PCS) / listed |
| 0VLP3DZ | Occlusion of left vas deferens with intraluminal device, percutaneous approach (ICD-10-PCS) / listed |
Occlusion of vas deferens with intraluminal devicemixed
| 0VLN0DZ | Occlusion of R vas deferens with intraluminal device, open approach |
| 0VLN3DZ | Occlusion of R vas deferens with intraluminal device, percutaneous approach |
| 0VLN4DZ | Occlusion of R vas deferens with intraluminal device, percutaneous endoscopic |
| 0VLN8DZ | Occlusion of R vas deferens with intraluminal device, via natural or artificial opening endoscopic |
| 0VLP0DZ | Occlusion of L vas deferens with intraluminal device, open approach |
| 0VLP3DZ | Occlusion of L vas deferens with intraluminal device, percutaneous approach |
| 0VLP4DZ | Occlusion of L vas deferens with intraluminal device, percutaneous endoscopic |
| 0VLP8DZ | Occlusion of L vas deferens with intraluminal device, via natural or artificial opening endoscopic |
| 0VLQ0DZ | Occlusion bilateral vas deferens with intraluminal device, open |
ICD-10-PCS - vas deferens occlusion with intraluminal deviceICD-10Covered
| 0VLN4DZ | Occlusion, right vas deferens, intraluminal device, percutaneous endoscopic (as listed) |
| 0VLN8DZ | Occlusion of right vas deferens with intraluminal device, via natural or artificial opening endoscopic (as listed) |
| 0VLP0DZ | Occlusion of left vas deferens with intraluminal device, open approach (as listed) |
| 0VLP3DZ | Occlusion of left vas deferens with intraluminal device, percutaneous approach (as listed) |
| 0VLP4DZ | Occlusion left vas deferens with intraluminal device, percutaneous endoscopic (as listed) |
| 0VLP8DZ | Occlusion of left vas deferens with intraluminal device, via natural or artificial opening endoscopic (as listed) |
| 0VLQ0DZ | Occlusion bilateral vas deferens with intraluminal device, open (as listed) |
| 0VLQ3DZ | Occlusion bilateral vas deferens with intraluminal device, percutaneous (as listed) |
| 0VLQ4DZ | Occlusion bilateral vas deferens with intraluminal device, percutaneous endoscopic (as listed) |
| 0VLQ8DZ | Occlusion of bilateral vas deferens with intraluminal device, via natural or artificial opening endoscopic (as listed) |
Vas deferens occlusion and epididymis release codesICD-10Covered
| 0VLP3DZ | Occlusion of left vas deferens with intraluminal device, percutaneous approach |
| 0VLP4DZ | Occlusion left vas deferens with intraluminal device, percutaneous endoscopic |
| 0VLP8DZ | Occlusion of left vas deferens with intraluminal device, via natural or artificial opening endoscopic |
| 0VLQ0DZ | Occlusion bilateral vas deferens with intraluminal device, open |
| 0VLQ3DZ | Occlusion bilateral vas deferens with intraluminal device, percutaneous |
| 0VLQ4DZ | Occlusion bilateral vas deferens with intraluminal device, percutaneous endoscopic |
| 0VLQ8DZ | Occlusion of bilateral vas deferens with intraluminal device, via natural or artificial opening endoscopic |
| 0VLP0DZ | Occlusion of left vas deferens with intraluminal device, open approach |
| 0VNJ0ZZ | Release right epididymis, open approach |
| 0VNJ3ZZ | Release right epididymis, percutaneous approach |
Genitourinary ICD-10-PCS procedures (occlusion/release)mixed
| 0VLQ0DZ | Occlusion, bilateral vas deferens, intraluminal device, open |
| 0VLQ3DZ | Occlusion, bilateral vas deferens, intraluminal device, percutaneous |
| 0VLQ4DZ | Occlusion, bilateral vas deferens, intraluminal device, percutaneous endoscopic |
| 0VLQ8DZ | Occlusion of bilateral vas deferens with intraluminal device, via natural or artificial opening endoscopic |
| 0VLP4DZ | Occlusion, left vas deferens, intraluminal device, percutaneous endoscopic (left) |
| 0VLP8DZ | Occlusion of left vas deferens with intraluminal device, via natural or artificial opening endoscopic |
| 0VNJ0ZZ | Release right epididymis, open approach |
| 0VNJ3ZZ | Release right epididymis, percutaneous approach |
| 0VNJ4ZZ | Release right epididymis, percutaneous endoscopic approach |
ICD-10-PCS procedure codes (fragment)ICD-10
| 0VLP4DZ | Procedure code listed in section (no full description in this fragment) |
| 0VLP8DZ | Procedure code listed in section (no full description in this fragment) |
| 0VLQ0DZ | Procedure code listed in section (no full description in this fragment) |
| 0VLQ3DZ | Procedure code listed in section (no full description in this fragment) |
| 0VLQ4DZ | Procedure code listed in section (no full description in this fragment) |
| 0VLQ8DZ | Procedure code listed in section (no full description in this fragment) |
| 0VNJ0ZZ | Procedure code listed in section (no full description in this fragment) |
| 0VNJ3ZZ | Procedure code listed in section (no full description in this fragment) |
| 0VNJ4ZZ | Procedure code listed in section (no full description in this fragment) |
| 0VNJ8ZZ | Procedure code listed in section (no full description in this fragment) |
ICD-10-PCS procedure codes for epididymis and spermatic cord proceduresICD-10Covered
| 0VNK8ZZ | Release left epididymis, via natural or artificial opening endoscopic |
| 0VNL0ZZ | Release bilateral epididymis, open approach |
| 0VQF0ZZ | Repair right spermatic cord, open approach |
| 0VQG0ZZ | Repair left spermatic cord, open approach |
| 0VQH0ZZ | Repair bilateral spermatic cords, open approach |
ICD-10-PCS repair codes for spermatic cords and epididymisICD-10
| 0VQG0ZZ | Repair left spermatic cord, opening endoscopic |
| 0VQG3ZZ | Repair left spermatic cord, open approach |
| 0VQG4ZZ | Repair left spermatic cord, percutaneous approach |
| 0VQG8ZZ | Repair left spermatic cord, percutaneous endoscopic approach |
| 0VQH0ZZ | Repair bilateral spermatic cords, opening endoscopic |
| 0VQH3ZZ | Repair bilateral spermatic cords, open approach |
| 0VQH4ZZ | Repair bilateral spermatic cords, percutaneous approach |
| 0VQH8ZZ | Repair bilateral spermatic cords, percutaneous endoscopic / via natural or artificial opening endoscopic |
| 0VQJ0ZZ | Repair right epididymis, open approach |
ICD-10-PCS codes for spermatic cord and epididymis repairsICD-10Covered
| 0VQG4ZZ | Repair left spermatic cord, percutaneous endoscopic approach |
| 0VQG8ZZ | Repair left spermatic cord, via natural or artificial opening endoscopic |
| 0VQH0ZZ | Repair bilateral spermatic cords, open approach |
| 0VQH3ZZ | Repair bilateral spermatic cords, percutaneous approach |
| 0VQH4ZZ | Repair bilateral spermatic cords, percutaneous endoscopic approach |
| 0VQH8ZZ | Repair bilateral spermatic cords, via natural or artificial opening endoscopic |
| 0VQJ0ZZ | Repair right epididymis, open approach |
| 0VQJ3ZZ | Repair right epididymis, percutaneous approach |
| 0VQJ4ZZ | Repair right epididymis, percutaneous endoscopic approach |
ICD-10-PCS repair codes for spermatic cords and epididymisICD-10Covered
| 0VQH3ZZ | Repair bilateral spermatic cords, open approach |
| 0VQH4ZZ | Repair bilateral spermatic cords, percutaneous approach |
| 0VQH8ZZ | Repair bilateral spermatic cords, percutaneous endoscopic approach |
| 0VQJ0ZZ | Repair right epididymis, open approach |
| 0VQJ3ZZ | Repair right epididymis, percutaneous approach |
| 0VQJ4ZZ | Repair right epididymis, percutaneous endoscopic approach |
| 0VQJ8ZZ | Repair right epididymis, via natural or artificial opening endoscopic |
| 0VQK0ZZ | Repair left epididymis, open approach |
| 0VQK3ZZ | Repair left epididymis, percutaneous approach |
Epididymis and spermatic cord repair ICD-10-PCS codes (partial, repeated)ICD-10Covered
| 0VQJ0ZZ | Repair right epididymis, open approach |
| 0VQJ3ZZ | Repair right epididymis, percutaneous approach |
| 0VQJ4ZZ | Repair right epididymis, percutaneous endoscopic approach |
| 0VQJ8ZZ | Repair right epididymis, via natural or artificial opening endoscopic |
| 0VQK0ZZ | Repair left epididymis, open approach |
| 0VQK3ZZ | Repair left epididymis, percutaneous approach |
| 0VQK4ZZ | Repair left epididymis, percutaneous endoscopic approach |
| 0VQH4ZZ | Repair bilateral spermatic cords, percutaneous endoscopic approach |
| 0VQH8ZZ | Repair bilateral spermatic cords, via natural or artificial opening endoscopic |
Epididymis and spermatic cord repair ICD-10-PCS codesmixedCovered
| 0VQJ0ZZ | Repair right epididymis, open approach |
| 0VQJ3ZZ | Repair right epididymis, percutaneous approach |
| 0VQJ4ZZ | Repair right epididymis, percutaneous endoscopic approach |
| 0VQJ8ZZ | Repair right epididymis, via natural or artificial opening endoscopic |
| 0VQK0ZZ | Repair left epididymis, open approach |
| 0VQK3ZZ | Repair left epididymis, percutaneous approach |
| 0VQK4ZZ | Repair left epididymis, percutaneous endoscopic approach |
| 0VQK8ZZ | Repair left epididymis, via natural or artificial opening |
| 0VQH8ZZ | Repair bilateral spermatic cords, via natural or artificial opening endoscopic / opening endoscopic |
Epididymis repair and approach qualifiersICD-10Covered
| 0VQJ0ZZ | Repair right epididymis, open approach / (opening endoscopic appears as repeated qualifier) |
| 0VQJ3ZZ | Repair right epididymis, percutaneous approach |
| 0VQJ4ZZ | Repair right epididymis, percutaneous endoscopic approach |
| 0VQJ8ZZ | Repair right epididymis, via natural or artificial opening endoscopic |
| 0VQK0ZZ | Repair left epididymis, open approach |
| 0VQK3ZZ | Repair left epididymis, percutaneous approach |
| 0VQK4ZZ | Repair left epididymis, percutaneous endoscopic approach |
| 0VQK8ZZ | Repair left epididymis, via natural or artificial opening endoscopic |
| 0VQH8ZZ | Opening endoscopic (approach qualifier appears in listing) |
| 0VQL0ZZ | Endoscopic (appears in some lines as an additional code/qualifier) |
Documentation, review, and billing actions required
Documentation Required
ICD-10-PCS codes requiring QIO documentation review
The following ICD-10-PCS surgical procedure codes require submission of supporting documentation for review by SCDHHS's Quality Improvement Organization (QIO).
Billing Rule
Procedure code entries — include listed ICD-10-PCS codes
Procedure code entries list ICD-10-PCS codes and short descriptions including bypass procedures and occlusion of the vas deferens with intraluminal device; use the exact ICD-10-PCS code(s) shown on the claim.
Billing Rule
Report occlusion of vas deferens with intraluminal device by exact code
When billing occlusion of the vas deferens with an intraluminal device, report the specific ICD-10-PCS code that matches laterality and approach (examples shown below).
- 0VLN0DZ — Occlusion of right vas deferens with intraluminal device, open approach
- 0VLN3DZ — Occlusion of right vas deferens with intraluminal device, percutaneous approach
- 0VLN4DZ — Occlusion of right vas deferens with intraluminal device, percutaneous endoscopic
- 0VLN8DZ — Occlusion of right vas deferens with intraluminal device, via natural or artificial opening endoscopic
- 0VLP0DZ — Occlusion of left vas deferens with intraluminal device, open approach
- 0VLP3DZ — Occlusion of left vas deferens with intraluminal device, percutaneous approach
Billing Rule
ICD-10-PCS codes for vas deferens occlusion (listed)
ICD-10-PCS codes for occlusion of the vas deferens with an intraluminal device must be reported with the precise code corresponding to laterality and approach; the policy lists these codes as examples that require supporting documentation.
- 0VLN4DZ
- 0VLN8DZ
- 0VLP0DZ
- 0VLP3DZ
- 0VLP4DZ
- 0VLP8DZ
- 0VLQ0DZ
- 0VLQ3DZ
- 0VLQ4DZ
- 0VLQ8DZ
Billing Rule
Include codes for vas deferens occlusion and epididymis release
When billing for occlusion of vas deferens and release of epididymis, include the specific ICD-10-PCS codes that reflect both the occlusion (laterality/approach) and the epididymis release procedure.
- 0VLP0DZ, 0VLP3DZ, 0VLP4DZ, 0VLP8DZ — Occlusion of left vas deferens with intraluminal device (various approaches)
- 0VLQ0DZ, 0VLQ3DZ, 0VLQ4DZ, 0VLQ8DZ — Occlusion of bilateral vas deferens with intraluminal device (various approaches)
- 0VNJ0ZZ, 0VNJ3ZZ — Release right epididymis (open, percutaneous)
Billing Rule
Vas deferens occlusion and epididymis release — code list
The policy lists ICD-10-PCS procedure codes for occlusion of the vas deferens (various approaches and lateralities) and release of the epididymis; providers must use the exact listed codes on claims.
- 0VLQ0DZ, 0VLQ3DZ, 0VLQ4DZ, 0VLQ8DZ — Bilateral occlusion variants
- 0VLP4DZ, 0VLP8DZ — Left occlusion endoscopic variants
- 0VNJ0ZZ, 0VNJ3ZZ, 0VNJ4ZZ — Release right epididymis (open/percutaneous/percutaneous endoscopic)
Note
Procedure code list fragment — verify approach qualifiers
This section contains repeated ICD-10-PCS code lines and approach descriptors; when billing, ensure the code submitted matches the procedure performed and the approach qualifier listed in the code text.
Documentation Required
Supporting documentation requirement (heading)
Procedure Codes Requiring Supporting Documentation: codes shown under this heading require submission of supporting clinical documentation for QIO review.
Note
Procedure code listing — spermatic cord and epididymis (informational)
Informational code listing for repair of spermatic cords and right epididymis — include the specific ICD-10-PCS code that matches the laterality and approach when submitting claims.
- 0VQG0ZZ, 0VQG3ZZ, 0VQG4ZZ, 0VQG8ZZ — Repair left spermatic cord (various approaches)
- 0VQH0ZZ, 0VQH3ZZ — Repair bilateral spermatic cords (open variants)
- 0VQJ0ZZ — Repair right epididymis, open approach
Billing Rule
ICD-10-PCS procedure codes for spermatic cord and epididymis repair
ICD-10-PCS repair procedure codes for spermatic cord and epididymis repairs are listed with multiple approach variants; report the exact code that reflects laterality and approach.
- 0VQG4ZZ, 0VQG8ZZ — Repair left spermatic cord (percutaneous endoscopic / natural/artificial opening endoscopic)
- 0VQH0ZZ, 0VQH3ZZ, 0VQH4ZZ, 0VQH8ZZ — Repair bilateral spermatic cords (various approaches)
- 0VQJ0ZZ, 0VQJ3ZZ, 0VQJ4ZZ — Repair right epididymis (open, percutaneous, percutaneous endoscopic)
Billing Rule
ICD-10-PCS codes — spermatic cord and epididymis repair (report exact code)
List of ICD-10-PCS procedure codes for repair of bilateral spermatic cords and right epididymis includes open, percutaneous, and endoscopic approach codes; submit the code that exactly matches the procedure performed.
- 0VQH0ZZ, 0VQH3ZZ, 0VQH4ZZ, 0VQH8ZZ — Repair bilateral spermatic cords (approach variants)
- 0VQJ0ZZ, 0VQJ3ZZ, 0VQJ4ZZ, 0VQJ8ZZ — Repair right epididymis (approach variants)
Billing Rule
ICD-10-PCS repair codes — spermatic cords and epididymis
ICD-10-PCS repair codes for spermatic cords and epididymis are listed with laterality and approach qualifiers; ensure claims include the precise code and, where applicable, supporting documentation.
- 0VQH3ZZ, 0VQH4ZZ, 0VQH8ZZ — Repair bilateral spermatic cords (variants)
- 0VQJ0ZZ, 0VQJ3ZZ, 0VQJ4ZZ, 0VQJ8ZZ — Repair right epididymis (variants)
- 0VQK0ZZ, 0VQK3ZZ — Repair left epididymis (open/percutaneous)
Billing Rule
Procedure code list (partial) — epididymis/spermatic cord repairs
This partial procedure code list includes repair codes for right, left, and bilateral epididymis and spermatic cords across approaches; verify and bill the exact code that corresponds to the procedure performed.
- 0VQJ4ZZ, 0VQJ8ZZ — Repair right epididymis (percutaneous endoscopic / via natural/artificial opening endoscopic)
- 0VQK0ZZ, 0VQK3ZZ — Repair left epididymis (open / percutaneous)
Billing Rule
ICD-10-PCS procedure code list — epididymis and spermatic cord repairs
Providers must report the ICD-10-PCS codes listed for repair of right epididymis, left epididymis, and bilateral spermatic cords using the exact code that captures laterality and approach as shown.
- 0VQJ0ZZ, 0VQJ3ZZ, 0VQJ4ZZ, 0VQJ8ZZ — Repair right epididymis (various approaches)
- 0VQK0ZZ, 0VQK3ZZ, 0VQK4ZZ, 0VQK8ZZ — Repair left epididymis (various approaches)
- 0VQH8ZZ — Repair bilateral spermatic cords, via natural or artificial opening endoscopic
Billing Rule
Procedure code listing — epididymis repair and approach qualifiers
Epididymis repair codes and associated approach qualifiers are listed; when billing such repairs, include the exact ICD-10-PCS code reflecting the side and approach.
- 0VQJ3ZZ, 0VQJ4ZZ, 0VQJ8ZZ — Repair right epididymis (percutaneous / percutaneous endoscopic / endoscopic qualifiers)
- 0VQK0ZZ, 0VQK3ZZ, 0VQK4ZZ, 0VQK8ZZ — Repair left epididymis (various approaches)
- 0VQL0ZZ — Endoscopic qualifier appearing in listing
Definitions and approach/laterality descriptors
Assistant surgeon payment category
DefinitionA two-digit numeric code indicates the category under which assistance is being received.
LocationSee SECTION 4 Procedure Codes (Payment Category) for assistant surgeon eligible codes referenced on the SCDHHS website.
UseUsed to identify the assistant surgeon payment category on claims and in SCDHHS coding tables.
Supporting documentation requirement
RequirementThe listed ICD-10-PCS codes require supporting documentation for review by SCDHHS's Quality Improvement Organization (QIO).
Responsible partyProvider must include supporting documentation when submitting claims for these ICD-10-PCS codes.
ScopeApplies to the ICD-10-PCS surgical codes enumerated in SECTION 4 Procedure Codes under 'ICD-10-PCS SURGICAL CODES AND PROCEDURE CODES REQUIRING SUPPORTING DOCUMENTATION'.
Procedure description entries
Example descriptionsBYPASS STOMACH TO ILEUM; BYPASS STOMACH TO TRANSVERSE COLON; OCCLUSION OF R VAS DEFERENS WITH INTRALUM DEV.
FormatShort labels appear adjacent to ICD-10-PCS codes as brief procedure descriptors in SECTION 4.
PurposeProvides concise mapping from ICD-10-PCS code to an abbreviated procedure description for billing and review.
Occlusion of vas deferens with intraluminal device
Codes (sample)0VLN0DZ, 0VLN3DZ, 0VLN4DZ, 0VLN8DZ, 0VLP0DZ, 0VLP3DZ, 0VLP4DZ, 0VLP8DZ, 0VLQ0DZ
DefinitionOcclusion of vas deferens with placement of an intraluminal device; approach modifiers follow ICD-10-PCS conventions (open, percutaneous, percutaneous endoscopic, via natural/artificial opening endoscopic).
ContextThese ICD-10-PCS style entries are listed in SECTION 4 as procedures requiring supporting documentation for QIO review.
occlusion with intraluminal device
DescriptorPlacement of an intraluminal device to occlude the vas deferens (described in SECTION 4 as 'INTRALUMINAL DEVICE').
ImplicationUsed to indicate the specific procedural intent (occlusion) when mapping to ICD-10-PCS codes in the listing.
Related codesAppears with codes such as 0VLN4DZ, 0VLP4DZ, 0VLQ4DZ corresponding to percutaneous endoscopic or similar approaches.
approach (open | percutaneous | endoscopic)
Approach variantsOpen; Percutaneous; Percutaneous Endoscopic; Via Natural or Artificial Opening Endoscopic.
Usage in codesApproach qualifiers (e.g., OPEN APPROACH, PERC APPROACH, PERC ENDO, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC) appear alongside ICD-10-PCS codes in SECTION 4.
Examples0VLN0DZ (open), 0VLN3DZ (percutaneous), 0VLN4DZ (percutaneous endoscopic), 0VLN8DZ (via natural/artificial opening endoscopic).
Occlusion (vas deferens)
Procedure summaryOcclusion of vas deferens performed by placement of an intraluminal device; entries list laterality and approach variants.
Common codes0VLP0DZ (left, open), 0VLQ0DZ (bilateral, open), 0VLN0DZ (right, open).
Documentation noteThese occlusion codes are included in the SECTION 4 listing and are among those requiring supporting documentation for QIO review.
Release (epididymis)
ProcedureRelease of epididymis (surgical release), with specified approach variants (open, percutaneous, percutaneous endoscopic, via natural/artificial opening endoscopic).
Example codes0VNJ0ZZ (release right epididymis, open), 0VNJ3ZZ (percutaneous), 0VNJ4ZZ (percutaneous endoscopic), 0VNK8ZZ (release left epididymis, via natural/artificial opening endoscopic).
LateralityRight, left, and bilateral release procedures are listed across SECTION 4 entries.
Occlusion of vas deferens
DefinitionOcclusion of vas deferens: placement of an intraluminal device to occlude the vas deferens; entries include approach and laterality variants.
Representative codes0VLQ0DZ, 0VLQ3DZ, 0VLQ4DZ, 0VLQ8DZ (bilateral occlusion with varying approaches).
Listing contextThese entries appear in SECTION 4's code listing and are identified among procedures requiring supporting documentation.
Release of epididymis
ProcedureSurgical release of right epididymis with approach variants (open, percutaneous, percutaneous endoscopic, via natural/artificial opening endoscopic).
Codes0VQJ0ZZ (open), 0VQJ3ZZ (percutaneous), 0VQJ4ZZ (percutaneous endoscopic), 0VQJ8ZZ (via natural/artificial opening endoscopic).
NotesApproach qualifiers and laterality are consistently listed with these codes in SECTION 4.
APPROACH / DESCRIPTION / ENDOSCOPIC
Label usageENDOSCOPIC appears as an approach descriptor attached to codes; APPROACH and DESCRIPTION labels are repeated in the SECTION 4 listings.
FunctionThese labels clarify the surgical approach and provide brief descriptors adjacent to ICD-10-PCS codes.
ExamplesLines include 'APPROACH' and 'DESCRIPTION = ...' followed by endoscopic qualifiers for codes such as 0VLP4DZ and 0VQG8ZZ.
Release of epididymis
ProceduresRelease of left or bilateral epididymis with approach variants (open, percutaneous, endoscopic, via natural/artificial opening endoscopic).
Codes0VNK8ZZ (left, via natural/artificial opening endoscopic), 0VNL0ZZ (bilateral, open), 0VNL3ZZ (bilateral, percutaneous).
ListingThese procedures and their approach qualifiers are listed in SECTION 4 under procedure codes requiring supporting documentation.
Repair of spermatic cord
ProceduresRepair of spermatic cord (right, left, bilateral) with multiple approach variants (open, percutaneous, percutaneous endoscopic, via natural/artificial opening endoscopic).
Example codes0VQF0ZZ (repair right spermatic cord, open), 0VQG0ZZ (repair left spermatic cord, opening endoscopic), 0VQH0ZZ (repair bilateral spermatic cords, open).
Approach qualifiersSECTION 4 entries list opening endoscopic, open, percutaneous, percutaneous endoscopic, and via natural/artificial opening endoscopic variants for these repairs.
Approach descriptors
Approach descriptorsOpening endoscopic; Open approach; Percutaneous approach; Percutaneous endoscopic; Via natural or artificial opening endoscopic.
RoleUsed consistently in SECTION 4 to indicate the surgical technique associated with each ICD-10-PCS repair code.
ExamplesCodes such as 0VQG0ZZ, 0VQG3ZZ, 0VQG4ZZ, 0VQG8ZZ show these approach descriptors in the listing.
Laterality
Laterality termsLeft; Right; Bilateral — used to indicate anatomical side(s) of the procedure in ICD-10-PCS entries.
ApplicationAppears with repair and release codes (e.g., 'REPAIR LEFT SPERMATIC CORD', 'REPAIR RIGHT EPIDIDYMIS', 'OCCLUSION BI VAS DEFERENS').
Claiming noteLaterality should match the billed code and supporting documentation submitted for QIO review.
Approach (ICD-10-PCS)
ICD-10-PCS approach variantsOpen; Percutaneous; Percutaneous Endoscopic; Via Natural or Artificial Opening Endoscopic.
RepresentationEach variant is indicated in SECTION 4 using qualifiers (e.g., OPEN APPROACH, PERCUTANEOUS APPROACH, PERC ENDO, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC).
ExamplesCodes: 0VQH3ZZ (open), 0VQH4ZZ (percutaneous), 0VQH8ZZ (via natural/artificial opening endoscopic).
Laterality
MeaningLaterality indicates the anatomical side(s) of the repair: left, right (epididymis), or bilateral (spermatic cords).
UsageUsed to select the correct ICD-10-PCS code variant in SECTION 4 listings and for claims submission.
Examples0VQJ0ZZ (right epididymis, open), 0VQK0ZZ (left epididymis, open), 0VQH0ZZ (bilateral spermatic cords, open).
open approach
Open approach — briefSurgical repair performed via an open incision (listed with codes such as 0VQH3ZZ, 0VQJ0ZZ, 0VQK0ZZ).
Example codes0VQH3ZZ (repair bilateral spermatic cords, open), 0VQJ0ZZ (repair right epididymis, open).
ContextOpen approach qualifiers appear throughout SECTION 4 to clarify technique for repair procedures.
percutaneous approach
DefinitionPercutaneous approach — repair performed through the skin without a large incision (codes include 0VQH4ZZ, 0VQJ3ZZ, 0VQK3ZZ).
Examples0VQH4ZZ (repair bilateral spermatic cords, percutaneous), 0VQJ3ZZ (repair right epididymis, percutaneous).
AppearanceSECTION 4 lists these qualifiers alongside the corresponding ICD-10-PCS codes for clarity.
percutaneous endoscopic approach
DefinitionPercutaneous endoscopic approach — endoscopic repair performed percutaneously (codes include 0VQH8ZZ, 0VQJ4ZZ, 0VQJ8ZZ).
Examples0VQH8ZZ (repair bilateral spermatic cords, percutaneous endoscopic), 0VQJ4ZZ (repair right epididymis, percutaneous endoscopic).
NotationShown in SECTION 4 as 'PERCUTANEOUS ENDOSCOPIC' or similar qualifiers adjacent to codes.
via natural or artificial opening endoscopic
DefinitionVia natural or artificial opening endoscopic — endoscopic approach entering through a natural or artificial body opening (used with codes such as 0VQG8ZZ, 0VQH8ZZ, 0VQJ8ZZ).
Examples0VQG8ZZ (repair left spermatic cord via natural/artificial opening endoscopic), 0VQJ8ZZ (repair right epididymis via natural/artificial opening endoscopic).
Document contextSECTION 4 lists this qualifier repeatedly for repair and release procedure codes.
Open approach
Examples0VQH3ZZ, 0VQJ0ZZ, 0VQK0ZZ are cited in SECTION 4 as open repair procedure codes.
ContextThese example codes illustrate open-approach repair entries for spermatic cords and epididymis.
UsageUsed when billing open surgical repair procedures in the genitourinary repair section of SECTION 4.
Percutaneous approach
Examples0VQH4ZZ, 0VQJ3ZZ, 0VQK3ZZ exemplify percutaneous repair codes listed in SECTION 4.
ContextThese codes are shown with 'PERCUTANEOUS APPROACH' qualifiers in the repair listings.
ImplicationSelect these codes when the procedure is performed percutaneously without an open incision.
Percutaneous endoscopic / via natural or artificial opening endoscopic
Examples0VQH8ZZ, 0VQJ4ZZ, 0VQJ8ZZ appear as percutaneous endoscopic or via natural/artificial opening endoscopic repair entries.
ContextThese example codes are repeatedly listed with endoscopic qualifiers in SECTION 4 for repair procedures.
SelectionUse these codes when the repair is performed endoscopically via percutaneous or natural/artificial opening routes.
Procedure code list
Code examples0VLN0DZ, 0VLP0DZ, 0VLQ0DZ, 0VNJ0ZZ, 0VQJ0ZZ
PatternICD-10-PCS entries in SECTION 4 include both laterality and approach qualifiers in the code text for accurate mapping and billing.
PurposeProvides a consolidated list of procedure codes indicating laterality and approach to guide claims submission and QIO review.
open approach
Open approach — definitionSurgical repair performed via an open incision (as indicated by 'OPEN APPROACH' in SECTION 4).
Example codes0VQH3ZZ, 0VQJ0ZZ, 0VQK0ZZ are listed with open qualifiers in SECTION 4.
ContextUsed to denote technique for repair procedures of epididymis and spermatic cords.
percutaneous approach
Percutaneous approach — definitionRepair performed through the skin without a large incision (indicated by 'PERCUTANEOUS APPROACH').
Example codes0VQH4ZZ, 0VQJ3ZZ, 0VQK3ZZ are cited as percutaneous approach variants.
Listing noteSECTION 4 pairs these qualifiers with corresponding ICD-10-PCS codes for clarity in claims and documentation.
percutaneous endoscopic approach
Percutaneous endoscopic — definitionEndoscopic repair performed percutaneously (shown as 'PERCUTANEOUS ENDOSCOPIC' in SECTION 4).
Example codes0VQH8ZZ, 0VQJ4ZZ, 0VQJ8ZZ listed with this qualifier.
UseApplicable when the repair is performed endoscopically through a percutaneous route.
via natural or artificial opening endoscopic
Via natural/artificial opening endoscopic — definitionEndoscopic approach entering via a natural or artificial opening (appears as a qualifier for many repair and release codes).
Example codes0VQG8ZZ, 0VQH8ZZ, 0VQJ8ZZ, 0VQK8ZZ appear with this qualifier in SECTION 4.
DocumentationListed repeatedly in SECTION 4 to specify technique for code selection and review.
Epididymis repair (ICD-10-PCS codes)
Epididymis repair codes0VQJ0ZZ (right, open), 0VQJ3ZZ (right, percutaneous), 0VQJ4ZZ (right, percutaneous endoscopic), 0VQK0ZZ (left, open).
LateralityEntries explicitly indicate right, left, or bilateral epididymis repair variants across approach qualifiers.
Approach qualifiersSECTION 4 repeats approach qualifiers adjacent to these epididymis repair codes to guide code selection.
Approach qualifiers
Approach qualifiers listOpen approach; Percutaneous approach; Percutaneous endoscopic approach; Via natural or artificial opening endoscopic.
PurposeThese qualifiers are used throughout SECTION 4 to indicate surgical technique for listed procedure codes.
Example codesQualifiers accompany codes such as 0VQJ0ZZ, 0VQJ3ZZ, 0VQJ4ZZ, 0VQK8ZZ in the listings.
Policy Summary
PayerSouth Carolina Department of Health and Human Services
PolicySECTION 4 Procedure Codes — Procedure codes requiring supporting documentation and assistant surgeon payment categories
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateN/A
Next Review DateN/A
Key ActionInclude supporting documentation with claims for listed ICD-10-PCS procedure codes for QIO review.
SourceLink
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