Urology Coding Alert

Report F52.21 for ED due to a mental disturbance.

Coding for erectile dysfunction (ED) can be challenging because you have to know if the ED is due to organic origin or a mental disturbance. Your coding choices will differ for each type of diagnosis. You must also understand the different types of postprocedural ED.

Answer the following questions to always submit clean ED claims in your urology practice.

First, Define Erectile Dysfunction for Clarity

Question 1: What is erectile dysfunction (ED)?

Answer: ED is the inability to achieve or keep an erection adequate for sexual activity.

ED can be either psychological or physiological.

Psychological factors alone are responsible for ED in few cases. Psychological ED can be caused by stress, anxiety, depression, guilt, low self-esteem, relationship conflicts, and worry about sexual performance, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.

On the other hand, physiological ED occurs the majority of the time. Physiological ED is caused by inadequate blood flow to the penis.

Pinpoint Correct Codes for Organic ED

Question 2: My urologist diagnosed a patient with ED of organic origin. Which ICD-10-CM codes should I report for this condition?

Answer 2: If the patient’s ED is of organic origin, you should report a code from category N52.- (Male erectile dysfunction). You will have to opt for proper expansion of this code based on what physiologic condition has caused the ED. The code expansions you can choose from, depending on the condition which has caused the ED, include the following:

• N52.01 (Erectile dysfunction due to arterial insufficiency).
• N52.02 (Corporo-venous occlusive erectile dysfunction).
• N52.03 (Combined arterial insufficiency and corporo-venous occlusive erectile dysfunction).
• N52.1 (Erectile dysfunction due to diseases classified elsewhere). Note: ICD-10-CM instructs you to code first the underlying disease when reporting N52.1.
• N52.2 (Drug-induced erectile dysfunction).
• N52.8 (Other male erectile dysfunction).
• N52.9 (Male erectile dysfunction, unspecified). Note: Code N52.9 also includes impotence NOS.

Remember: “Many insurance carriers at the present time have provided contracts that contain waivers excluding reimbursement for erectile dysfunction and therefore, will not reimburse for any services for this clinical problem,” Ferragamo says. “Offices should check with carriers and inform patients of their possible responsibility for payment of these services.”

Rely on 1 Code for ED due to Mental Disturbance

Question 3: My urologist diagnosed a patient with ED due to a mental disturbance. Which ICD-10-CM code should I report for this condition?

Answer: If the patient’s ED is not of organic origin and is more due to a mental disturbance, report this type of ED with code F52.21 (Male erectile disorder).

Coding tip: Code F52.21 also includes ED and psychogenic impotence, per ICD-10-CM.

Focus on N52.35 for ED Following Radiation Therapy

Question 4: A patient with prostate cancer was diagnosed with ED following radiation therapy. What ICD-10-CM code should we report on the claim?

Answer 4: For ED following radiation therapy, you should report code N52.35 (Erectile dysfunction following radiation therapy).

Coding tip: ICD-10-CM offers codes for ED by specific modes of radiotherapy. For ED following interstitial seed therapy, you report code N52.36 (Erectile dysfunction following interstitial seed therapy).

For ED following prostate ablative therapy, you should report code N52.37 (Erectile dysfunction following prostate ablative therapy).

Note: Code N52.37 also includes ED following cryotherapy, ED following other prostate ablative therapies, and ED following ultrasound ablative therapies.

Don’t miss: “Erectile dysfunction (ED) can begin immediately following a radical prostatectomy with the removal of the entire prostate and surrounding tissues. However, the onset of ED following radiation therapy is gradual and usually begins within 2 to 3 years following treatment,” according to AHA ICD-10-CM Coding Clinic Volume 3, Issue 4. “When hormone therapy is used, ED may occur approximately 2 to 4 weeks following the initiation of the therapy and is usually accompanied by a decreased desire for sex. In either case, without treatment, the ED is usually permanent.”

Differentiate Between Codes for Radical, Simple Prostatectomy

Question 5: My urologist diagnosed a patient with ED following a radical prostatectomy. Which ICD-10-CM code should I report for this condition?