Urology Coding Alert

Question: A patient presented with a penile ring or device that encircled the penis producing edema that prevented its simple removal. The patient was taken directly to the operating room, and using a diamond tipped blade saw the urologist cut the ring off. The urologist then performed a cystoscopic examination and a penile Doppler to check for internal damage. Do I count the cystoscopy as part of the procedure code or bill it out separately? Also, is 55899 the code to use for the penile ring removal? My diagnosis codes are 607.83, 959.14, and E928.5.

Kansas Subscriber

Answer: Since there is no specific code for the cutting of a metal ring around the penis that causes penile edema, which restricts simple removal, use code 55899 (Unlisted procedure, male genital system) for the cutting of the ring and its removal. Also code 52000 (Cystourethroscopy) and 93980 (Duplex scan of arterial inflow and venous outflow of penile vessels; complete study) for the cystoscopic examination and penile Doppler studies.

The diagnoses you list -- 607.83 (Edema of penis), 959.14 (Other injury of external genitals), and E928.5 (External constriction caused by other object) are correct.

Pointer: Remember that when you're using an unlisted code, you should provide the payer with a detailed operative report and a covering letter clearly and simply stating in laymen's terms what was done, how it was done, and why.