Know Carrier Restrictions to Effectively Bill for Duplex Scans of Penile Blood Flow
Published on Sun Oct 01, 2000
The incidence of erectile dysfunction (ED) is increasing in the United States. This has resulted in greater demand for diagnostic tests that identify underlying causes and suggest treatments with the greatest likelihood of success. Among these tests are several radiological studies that may not be reimbursable if coded incorrectly. But with a firm grasp on coding policies, radiology coders can effectively maximize reimbursement for erectile dysfunction studies.
ED currently affects 15 to 25 percent of American men older than 65. Medical professionals predict this number will grow as the average age of the population rises. The number of younger men suffering from the condition is also mounting because ED is recognized more widely as a side effect of diseases like diabetes and hypertension.
Likewise, radiology practices report an escalating number of patients being seen for noninvasive vascular diagnostic studies, which allow the ultrasound technologist and radiologist to assess penile blood flow. Reimbursement policies for these scans, however, vary widely from region to region and carrier to carrier.
Coding Duplex Scanning
Duplex scanning of penile blood flow has become the diagnostic method of choice, according to Richard Brebner, BS, RDMS, RDCS, RVT, vice president and technical director for Ultrasound Services Inc., which provides diagnostic ultrasound services in Pennsylvania, Delaware and New Jersey. These studies are described in CPT Codes 93980 (duplex scan of arterial inflow and venous outflow of penile vessels; complete study) and 93981 ( ... follow-up or limited study).
We are seeing more men younger than 60 with erectile dysfunction, Brebner says. The underlying reason for the condition may be either psychosexual or organic. The duplex scan is performed to evaluate how well the blood is flowing to the penis to create and maintain an erection. Obviously, if there is a stenosis or blockage of the artery, we know there is an organic cause and can treat the patient accordingly.
During the study, the patient is injected with a vasoactive agent to force blood into the penis. An ultrasound will display a two-dimensional structure of the vessels and motion with time. In addition, the duplex scan will include Doppler ultrasound signal documentation with spectrum analysis and color flow velocity mapping or imaging.
The procedure is coded 93980, and the injection would most likely be bundled into the procedure, according to Susan Callaway-Stradley, CPC, an independent coding consultant and educator in North Augusta, S.C.
Although there are injection and drug codes that may be assigned in addition to 93980 in some instances (i.e., CPT 54235 , injection of corpora cavernosa with pharmacologic agent[s] [e.g., papaverine, phentolamine]; and J2440, injection, papaverine HCl, up to 60 mg), Callaway-Stradley notes that Medicare places strict frequency limitations on how often they are used for the diagnosis [...]
