Urology Coding Alert
Reporting Underlying Condition for Female Sexual Dysfunction Differs From Male
Although many reimbursable codes exist for male erectile dysfunction, coding for women with female sexual dysfunction (FSD) is more elusive. Sexual dysfunction is generally considered an age-related and a predominately male condition, so carriers may not have many local medical review policies for the disorder. Organic causes that prove medical necessity are usually required for reimbursement. Diagnosis for Initial Visit When a physician examines a patient for FSD, you should use an office consultation code (99241-99245) or a new patient office visit code (99201-99205) linked with the appropriate diagnosis: Psychosexual diagnoses should be used as secondary diagnoses when associated with the above. Many carriers will not pay for psychosexual problems as the primary diagnosis. Such diagnoses include: In addition, some medications, such as benzodiazepines, might cause FSD. You should report 995.2 (Unspecified adverse effect of drug, medicinal and biological substance). There are many possible underlying causes of FSD, according to Nancy A. Phillips, MD, author of "Female Sexual Dysfunction: Evaluation and Treatment" published in American Family Physician (July 1, 2000). Diabetes, arthritis, urinary incontinence and other conditions frequently cause sexual problems, she writes. So does recurrent cystitis. Hysterectomy, breast cancer and any gynecologic malignancy can result in decreased desire. Ask your carrier if it has a local medical review policy on FSD. You should also have the patient sign an advance beneficiary notice or financial waiver so the practice can collect from the patient if the insurer refuses coverage. Codes for Male Versus Female Sexual Dysfunction The following codes are used in the treatment of erectile dysfunction: However, the only code for treatment of FSD (when not referring to the underlying causes) is L7900. Even though the vacuum device is investigational and not covered, you should still use L7900 to report it. Because most carriers do not reimburse for this treatment, you should have the patient purchase the product with a prescription.
For men, treatment for erectile dysfunction includes treating the underlying organic cause (such as diabetes mellitus), Viagra (not recommended for women, and not payable by Medicare because it's a drug), intracavernosal injections, a vacuum erection device (L7900, Vacuum erection system), and implantation of a penile device (54400, 54405). Viagra is payable by private payers at various frequencies. The labeling indicates no more than one tablet a day, so private payers decide how many tablets are allowed as many as six to 10 tablets a month.
For women, management includes treating the underlying cause (such as diabetes mellitus) or estrogen replacement subcutaneously (11980, Subsequent hormone pellet implantation [implantation of estradiol and/or testosterone pellets beneath the skin]). There is also a new device called Eros Therapy, from UroMetrics. This device is a handheld vacuum, which causes the clitoris to become engorged. The HCPCS code for this device is L7900.
The basic treatment strategies for FSD, Phillips writes, include education, pelvic muscle exercises, estrogen replacement, and now the investigational vacuum device.
Urology Coding Alert
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