Urology Coding Alert

Question:One of our physicians is injecting lidocaine into the patient before he performs 54200. He is wanting to bill 54235 as well. He states, "I am not simply doing a subq-lidocaine injection for a local anesthetic – this is a much deeper and more involved injection that does involve the corpora cavernosa." Can he bill the 54235 even though it's lidocaine and not a drug to cause an erection?

Illinois Subscriber

Answer: Injection of a vasodilator is not the same as a penile block, which is bundled into the 54200 (Injection procedure for Peyronie disease). Because of this, you should report only 54200 and not include 54235 (Injection of corpora cavernosa with pharmacologic agent[s] [e.g., papaverine, phentolamine]).

To put it simply: The physician is administering anesthesia. It doesn't matter how deep he goes into the penis, it is still just anesthesia, which is bundled into the procedure. This would definitely be called "abuse" or upcoding if noticed by an insurance company.