Urology Coding Alert

Some tests and procedures for impotence are not covered at all or are covered under only limited circumstances. Coders should check Medicare local medical review policies (LMRPs) for proper use of diagnosis codes when billing for impotence. By reviewing the LMRP on impotence (usually found under "erectile dysfunction") prior to filing the claim, you can avoid denials and enhance reimbursement. Initial Evaluation A urologist who sees a patient because of impotence has often been requested by the primary care provider (PCP) to render an opinion and offer some treatment options. You should bill this initial visit as a consultation (99241-99245) linked to 607.84 (Other specified disorders of penis; impotence of organic origin). Regardless of whether the PCP screens the patient and determines that the diagnosis is impotence, 607.84 is a payable diagnosis for the consultation, says Arthur Tarantino, MD, a urologist with Connecticut Surgical Group in Hartford. He adds that Medicare carriers should always pay for the initial evaluation based on this diagnosis. Commercial insurance plans may require additional diagnoses. Tests and Procedures Doctors are required by Medicare to conduct laboratory tests to rule out other problems, such as diabetes or medication, before conducting impotence testing or treatment. These laboratory tests are payable with signs and symptoms diagnoses (e.g., 780.79 [Other malaise and fatigue]) or with 607.84. Medicare national policy allows but doesn't require payment for diagnosis and treatment of impotence. Commercial carriers and HMOs usually have different rules, from no coverage of any impotence exam to coverage of many tests. Tests at issue include: 37788 Penile revascularization, artery, with or without vein graft 37790 Penile venous occlusive procedure 54230 Injection procedure for corpora cavernosography 54231 Dynamic cavernosometry, including intracavernosal injection of vasoactive drugs (e.g., papaverine, phentolamine) 54235 Injection of corpora cavernosa with pharmacologic agent(s) (e.g., papaverine, phentolamine) 54240 Penile plethysmography 54250 Nocturnal penile tumescence and/or rigidity test  93975 Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study 93976 limited study 93978 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study 93979 unilateral or limited study 93980 Duplex scan of arterial inflow and venous outflow of penile vessels; complete study 93981 follow-up or limited study.

Some carriers will pay for tests with 302.72 (Psychosexual dysfunction; with inhibited sexual excitement). Most will pay for some special tests if it is not clear whether the impotence is organic or mental in origin.

Decreased libido (257.2, Other testicular hypofunction) is often not covered for impotence testing because some carriers mistakenly view 257.2 as synonymous with impotence. If the patient complains of fatigue, a better diagnosis code might be 780.79. Billing 54235 There are some similarities among LMRPs, notably coverage of [...]