Urology Coding Alert

Although many reimbursable codes exist for male erectile dysfunction, coding for women with female sexual dysfunction (FSD) is more elusive. Sexual dysfunction is generally considered an age-related and a predominately male condition, so carriers may not have many local medical review policies for the disorder. Organic causes that prove medical necessity are usually required for reimbursement.

For men, treatment for erectile dysfunction includes treating the underlying organic cause (such as diabetes mellitus), Viagra (not recommended for women, and not payable by Medicare because it's a drug), intracavernosal injections, a vacuum erection device (L7900, Vacuum erection system), and implantation of a penile device (54400, 54405). Viagra is payable by private payers at various frequencies. The labeling indicates no more than one tablet a day, so private payers decide how many tablets are allowed as many as six to 10 tablets a month.

For women, management includes treating the underlying cause (such as diabetes mellitus) or estrogen replacement subcutaneously (11980, Subsequent hormone pellet implantation [implantation of estradiol and/or testosterone pellets beneath the skin]). There is also a new device called Eros Therapy, from UroMetrics. This device is a handheld vacuum, which causes the clitoris to become engorged. The HCPCS code for this device is L7900. Diagnosis for Initial Visit When a physician examines a patient for FSD, you should use an office consultation code (99241-99245) or a new patient office visit code (99201-99205) linked with the appropriate diagnosis:

616.0 Inflammatory disease of cervix, vagina, and vulva; cervicitis and endocervicitis

617.4 Endometriosis of rectovaginal septum and vagina

623.1 Noninflammatory disorders of vagina, leukoplakia of vagina

623.2 stricture or atresia of vagina

623.3 tight hymenal ring

623.4 old vaginal laceration

625.0 Pain and other symptoms associated with female genital organs; dyspareunia

625.1 vaginismus

627.3 Menopausal and postmenopausal disorders; postmenopausal atrophic vaginitis

752.41 Anomalies of cervix, vagina, and external female genitalia; embryonic cyst of cervix, vagina, and external female genitalia

752.42 imperforate hymen

752.49 other anomalies of cervix, vagina, and external female genitalia Psychosexual diagnoses should be used as secondary diagnoses when associated with the above. Many carriers will not pay for psychosexual problems as the primary diagnosis. Such diagnoses include:
302.71 Psychosexual dysfunction; with inhibited sexual desire 302.72 with inhibited sexual excitement 302.73 with inhibited female orgasm 302.76 with functional dyspareunia. In addition, some medications, such as benzodiazepines, might cause FSD. You should report 995.2 (Unspecified adverse effect of drug, medicinal and biological substance). There are many possible underlying causes of FSD, according to Nancy A. Phillips, MD, author of "Female Sexual Dysfunction: Evaluation and Treatment" published in American Family Physician (July 1, 2000). Diabetes, arthritis, urinary incontinence and other conditions frequently cause sexual problems, she writes. So [...]