Urology Coding Alert

Many urology coders wonder how frequently they can bill 54235 (injection of corpora cavernosa with pharmacologic agent[s] [e.g., papaverine, phentolamine]). Usually it depends on the payer and if the patient is a contender for surgery. This is a procedure in which the penis is injected in order to treat an erectile dysfunction (607.82). The injection produces an erection that can last from a few minutes to several hours.

The frequency with which this can be billed depends on the Medicare carrier or commercial payer, explains Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Systems, a coding, reimbursement and compliance consulting firm in Denver, Colo. Several Medicare carriers have limited the benefit to once per beneficiary lifetime, she says. But you would need to check with the payer for specific guidelines.

This is precisely the kind of procedure for which payers tend to have widely varying guidelines. In addition to frequency, you need to determine what your carrier or payer requires in terms of medical necessity. In general, there must be evidence of organic impotency or a traumatic injury, says Page. Some payers will allow psychosexual dysfunction.

If a patient is not a good candidate for surgery (implants and pumps are other more permanent ways of dealing with this problem), it is possible that a payer would make an exception and allow more treatments.

Tip: You can bill for the injected material separately. Bill J0270 for alprostadil.