Urology Coding Alert

Question: How can we get paid for penile Doppler studies?

New York Subscriber

Answer: In the New York area, Medicare has tight coverage limits for penile and related Doppler studies. All Doppler studies are denied as not medically necessary. This includes 93980 (duplex scan of arterial inflow and venous outflow of penile vessels; complete study), 93981 (... follow-up or limited study) and 54240 (penile plethysmography). On occasion, these codes will be payable if there is a history of pelvic and/or perineal trauma. There must be documentation and a special report explaining the trauma and that a procedure on the pudendal vessels may be considered. For private payers, rules vary. Trial and error may be the only way to find out what the private payers rules are in your area for payment for penile Doppler studies. Explain to patients that the insurance company may deny payment. In the case of Medicare, obtain a waiver and use the -QA modifier (FDA investigational device exemption) on the procedure codes that you think may be denied. Then Medicare will inform the patient he may be responsible for the charges.