Urology Coding Alert

Question: What is the correct code for a penile doppler performed in the office?

Florida Subscriber

Answer: The correct code is 93980 (duplex scan of arterial inflow and venous outflow of penile vessels; complete study). In many places, however, this wont be paid for a Medicare patient. The procedure is performed for erectile dysfunction, and many Medicare carriers maintain that the routine use of this procedure isnt medically necessary.

On the contrary, most private payers do pay this code. So if the patient has commercial coverage, you probably will be paid for 93980. In addition, you should bill for the injection, using 54235 (injection of corpora cavernosa with pharmacologic agent[s] [e.g., papaverine, phentolamine]). The diagnosis code should be 607.84 (impotence of organic origin). Payers rules vary on this procedure and payment for the pharmaceuticals, so check with the payer for information on billing.