A patient who has been diagnosed with obstructive azoospermia (OA) may have trouble producing an adequate number of sperm for fertilization via intracytoplasmic sperm injection (ICSI). During an in-office procedure called percutaneous epididymal sperm aspiration (PESA), doctors retrieve sperm from the epididymis. Alternatively, they can perform testicular sperm aspiration (TESA).
Both TESA and PESA are performed under local anesthesia. They involve passing a needle through the scrotum or epididymis, then retrieving sperm from the seminiferous tubules under direct visualization with a microscope. These sperm are often immature or less motile than the sperm normally found in ejaculate. Moreover, a PESA or TESA result is not as reliable as an ejaculate sample.
However, a sperm count through a PESA or TESA is still better than no sperm count at all. The sperm retrieved with a TESA or PESA procedure can be used in more advanced fertility treatments such as ICSI.
The Arizona Center for Fertility Studies has done a significant number of TESA and ICSI cycles using sperm retrieved by a TESA procedure. Although sperm retrieved through PESA or TESA are usually no longer motile, the Arizona Center for Fertility Studies embryology laboratory can use these non-motile sperm with excellent fertilization and pregnancy rates.
The coding for a TESA is S4028 (Percutaneous sperm aspiration of the testis). You should report it to Medicare and most private payers, but note that some payers don’t recognize S codes. To avoid denials, many urology practices require patients to sign an advance beneficiary notice (ABN) before they have a TESA or PESA, advises Young. tesa mesa