When a patient complains of erectile dysfunction, the urologist must choose a diagnosis code carefully to be paid for the visit. Organic impotence (607.84, impotence of organic origin) is payable, but psychogenic impotence (302.72, psychosexual dysfunction; with inhibited sexual excitement) usually isn't at least not for a urologist.
Unless the urologist can document that the impotence is organic, the coder is stuck with 302.72, which is frequently not paid, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer based in North Augusta, S.C. "You may just have the patient telling you it doesn't work," Callaway says. But the urologist can't code 607.84 just to be paid. "The physician has to be confident that the impotence has an organic origin before coding 607.84."
The diagnosis coding dilemma for impotence is a typical one, according to Callaway. "The coding world and the reimbursement world don't always agree," she says. "It shouldn't make a difference if you use a mental-health code." If the urologist determines the problem is psychogenic, 302.72 is the correct code. But billing that code means you won't be paid. "The minute you use a code from the psych section, your whole reimbursement scenario changes," she says.
Urologists should not use 302.72, because these cases probably belong in a psychiatrist's office. Payers see it the same way because most will not pay a urologist to treat a mental-health diagnosis.
"As soon as they see the mental-health diagnosis, the payer will automatically put it into mental-health benefits," says Laura Siniscalchi, RHIA, CCS, CCS-P, CPC, senior consultant with Deloitte and Touche in Boston. "That means they won't pay a urologist." Medicare, when it pays 302.72, does so at a reduced rate.
Some Testing Is Covered
Even for organic impotence, Medicare will no longer pay for an extensive battery of diagnostic tests. The diagnosis will have to be based almost entirely on the history and physical, says Michael A. Ferragamo, MD, clinical assistant professor of
Urology at the State University of New York, Stonybrook.
"They want you to do less testing, and instead diagnose from the history, physical exam and a few lab tests," Ferragamo says. The lab tests are mainly to rule out other problems such as diabetes.
Except for the impotence diagnosis itself, there are few diagnostic tests. Always payable are the urologist's history, exam and medical decision-making the main components of the E/M service. Medicare will pay for certain tests with a diagnosis of organic impotence; however, these tests are not designed to help diagnose the impotence, but rather to rule out other causes of the impotence.
For example, Medicare will cover a CBC (complete blood count), glucose and lipid profile (if they haven't been done within the past six [...]
