Urology Coding Alert

Question: We have a male patient that our doctor would like to inject with Coaptite® because of stress incontinence following a radical prostatectomy. The literature states that it is for use in adult females, but the rep from Boston Scientific states he has a urologist doing them on males and getting paid. The patient has Medicare insurance coverage. Can we report this procedure to Medicare for a male patient, and if so, how?

Wisconsin Subscriber

Answer: You can report this procedure for either male or female patients. You would use CPT® code 51715 (Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck) regardless of the patient's gender.

Don't miss: For the implant material you should also report HCPCS code L8606 (Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies) times the number of syringes used to the local payer who is reimbursing for the 51715 procedure code and not to the Durable Medical Equipment Regional Office (DMERO).