Tesa Mesa and PESA

tesa mesa is a procedure used to retrieve sperm from the testis for men with obstructive azoospermia from a prior vasectomy or infection. It is done with local anesthesia in the operating room or office and coordinated with their female partner’s egg retrieval. It involves placing a needle through the skin of the scrotum into either the epididymis or testicle to aspirate tissue/sperm. Occasionally, a tesa cannot provide enough tissue/sperm and an open testis biopsy (TESE) is required.

Several studies show severe damage and inflammatory complications after the needle prick injury caused by TESA. A significant up-regulation of germ cell apoptosis was observed in both the contralateral and the ipsilateral testis following TESA. This was attributed to both paracrine and immunological factors, but also due to the trauma caused by needle insertion through the seminiferous tubules.

PESA is similar to TESA except it does not require an incision and does not expose the testicle. It is also more expensive than TESE. However, it can be less effective as it is difficult to collect a large amount of sperm using this technique.

Most insurance companies reimburse for both tesa and ptesa, but check with your specific payer. Some payers do not recognize S codes (S4028), which are temporary national code for which Medicare does not pay. You will then report an unlisted-procedure code, 55899 (Unlisted procedure, male genital system), for all payers. If you are billing Medicare, make sure to use the CPT code that reflects the procedure you are doing. tesa mesa

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