lcouto
Networker
We have a new Vascular Doctor who joined our group and specializes in ED Dysfunction. This is completely new for us as we are a cardiology practice and expanding. He asked me to research these codes but the diagnosis codes he is supplying are not payable from what I can tell. I was hoping that some one could help me . I have copied his 2 emails to me and what he is asking:
Medicare diagnosis code (NCD 230.4) covers diagnosis and treatment of sexual impotence. Please see description below from medicare.gov
The procedures that I do to treat ED are:
Procedure 1 CPT codes (endovascular stent placement)
36245 & 37221
Procedure 2 CPT codes (endovascular stent placement)
36245 & 37236
Procedure 3 CPT codes (endovascular balloon angioplasty)
36245 & 37246
Procedure 4 CPT code (endovascular penile leak embolization)
37241
When I communicated with medicare, they informed me that medicare may cover Procedure 4 CPT code 37241 based on documentation supporting medical necessity.
Given that medicare has LCD L35998 and Billing and Coding article A57590 on Non-Coronary Vascular Stents which would only allow CPT codes 37221 and 37236 when billed with an approved diagnosis code listed in the article (however diagnosis NCD 230.4 is not listed in the article). Not sure if we can use an alternative diagnosis like atherosclerosis, unspecified
I am a vascular surgeon and expert in the treatment of male erectile dysfunction.
Patients who are non-responders to phosphodiesterase-5 inhibitors are screened for penile arterial insufficiency using penile duplex scan. If penile artery peak systolic velocity is <35 cm/s, then arterial insufficiency is suspected, and computed tomography (CT) angiogram is obtained to confirm presence of significant stenosis in iliac-pedundle-penile arterial system. Patients with penile arterial insufficiency are offered endovascular penile revascularization (EPR). EPR is a minimally invasive procedure that treats the iliac-pedundle-penile arterial disease by angioplasty and/or stenting.
Penile venous leak results in impotence in more than 50% of patients with vascular erectile dysfunction. Penile duplex scan can be used as a screening test to identify patients with penile venous leak with a sensitivity and specificity up to 78% and 89%, respectively. CT-cavernosography is used as a confirmatory test to diagnose venous leak and guide therapeutic interventions. Penile venous leak embolization with or without deep dorsal vein ligation is offered to patients with penile venous leak.
Please find attached one paper that I recently published on this topic.
As such, I offer patients iliac-pedundle-penile arterial angioplasty and/or stenting and penile venous leak embolization with or without deep dorsal vein ligation.
My question is: does medicare reimburse for the work-up and surgical treatment of this disease?
ICD-10 diagnosis code: N529, N5201, N5202 and N5203
Potential combinations of CPT codes for surgical intervention are:
CPT codes
36245 & 37221
CPT codes
36245 & 37236
CPT codes
36245 & 37246
CPT code
37241
Medicare diagnosis code (NCD 230.4) covers diagnosis and treatment of sexual impotence. Please see description below from medicare.gov
The procedures that I do to treat ED are:
Procedure 1 CPT codes (endovascular stent placement)
36245 & 37221
Procedure 2 CPT codes (endovascular stent placement)
36245 & 37236
Procedure 3 CPT codes (endovascular balloon angioplasty)
36245 & 37246
Procedure 4 CPT code (endovascular penile leak embolization)
37241
When I communicated with medicare, they informed me that medicare may cover Procedure 4 CPT code 37241 based on documentation supporting medical necessity.
Given that medicare has LCD L35998 and Billing and Coding article A57590 on Non-Coronary Vascular Stents which would only allow CPT codes 37221 and 37236 when billed with an approved diagnosis code listed in the article (however diagnosis NCD 230.4 is not listed in the article). Not sure if we can use an alternative diagnosis like atherosclerosis, unspecified
I am a vascular surgeon and expert in the treatment of male erectile dysfunction.
Patients who are non-responders to phosphodiesterase-5 inhibitors are screened for penile arterial insufficiency using penile duplex scan. If penile artery peak systolic velocity is <35 cm/s, then arterial insufficiency is suspected, and computed tomography (CT) angiogram is obtained to confirm presence of significant stenosis in iliac-pedundle-penile arterial system. Patients with penile arterial insufficiency are offered endovascular penile revascularization (EPR). EPR is a minimally invasive procedure that treats the iliac-pedundle-penile arterial disease by angioplasty and/or stenting.
Penile venous leak results in impotence in more than 50% of patients with vascular erectile dysfunction. Penile duplex scan can be used as a screening test to identify patients with penile venous leak with a sensitivity and specificity up to 78% and 89%, respectively. CT-cavernosography is used as a confirmatory test to diagnose venous leak and guide therapeutic interventions. Penile venous leak embolization with or without deep dorsal vein ligation is offered to patients with penile venous leak.
Please find attached one paper that I recently published on this topic.
As such, I offer patients iliac-pedundle-penile arterial angioplasty and/or stenting and penile venous leak embolization with or without deep dorsal vein ligation.
My question is: does medicare reimburse for the work-up and surgical treatment of this disease?
ICD-10 diagnosis code: N529, N5201, N5202 and N5203
Potential combinations of CPT codes for surgical intervention are:
CPT codes
36245 & 37221
CPT codes
36245 & 37236
CPT codes
36245 & 37246
CPT code
37241