Primary Care Coding Alert

Question: Which diagnosis code should I use for erectile dysfunction (ED)?

Missouri Subscriber

Answer: You should assign 607.84 (Other specified disorders of penis; impotence of organic origin) or 302.72 (Psychosexual dysfunction; with inhibited sexual excitement) depending on whether or not the family physician documents that the impotence is organic (involves bodily organs).
 
If the FP documents that a physiological condition, such as vascular disease, causes the patient's impotence, you should assign 607.84 as the primary diagnosis. Report the underlying condition, for instance diabetes mellitus (250.xx), as the secondary ICD-9 code.
 
For nonorganic ED, you should submit 302.72. Because ICD-9 classifies male ED as a mental disorder, some insurers don't cover claims containing 302.72.  Check with the insurer before reporting nonorganic ED services and procedures. Obtain an advance beneficiary notice informing the patient that if the payer denies coverage, payment is his responsibility.
 
Good news: Western Missouri Medicare considers both diagnoses payable. For instance, Blue Cross Blue Shield (BCBS) of Kansas' (Kansas, Nebraska and western Missouri's Part B carrier) local medical review policy states the carrier will pay for the first office visit in which the physician performs a papaverine injection (54235, Injection of corpora cavernosa with pharmacologic agent[s] [e.g., papaverine, phentolamin]]) to diagnose ED. The physician must append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate-level E/M service (such as 99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient ...).
 
Note: ICD-9 2005 now includes "male erectile disorder" under 302.72.
 
For BCBS's LMRP, see www.nebraskamedicare.com/part_B/LMRP/policies/ErectileDysfunctionTesting.htm.