What You Should Know About Peyronie’s Disease: Diagnosis and Billing Insights

Early clinical diagnosis:

Finding out the correct diagnosis on time is critical for effective treatment and can significantly impact the billing process. Urologists can easily intervene the occurrence of Peyronie's disease with the help of diagnostic testing, comprehensive physical examinations, and patient history.

Diagnostic Tests such as Ultrasound or Imaging:

✓ To visualize plaque and assess blood flow that helps in finding out the present stage of the disease (acute or chronic), which impacts on the methods of treatment.

Physical Examination:

✓ A physical examination can often uncover hardened plaques or lumps along the shaft; most found on the dorsal side of the penis.

Patient History:

✓ Asking about the onset of symptom, pain and trauma occurred

✓ Documenting any history of erectile dysfunction or family history of related conditions.

Photography:

✓ Documenting curvature for medical records and insurance claims.

Treatment Options for Peyronie’s Disease

Treatment for the disease depends on severity of the condition, and the phase (acute or chronic), also patient goals. There are a wide range of options available ranging from conservative management to surgical intervention.

• Acute Phase lasting for 5 to 18 months in which the scar tissue keeps growing causing pain and curvature of the penis.
• Chronic Phase the scar tissue gets stabilized, and the pain is reduced however it may cause Erectile Dysfunction.

Non-Surgical Treatments:

• Giving Oral Medications such as Pentoxifylline to reduce plaque size.
• Intralesional Injections such as Collagenase Clostridium histolyticum (Xiaflex) to break down plaque.
• Using Vacuum and Traction Therapy to straighten and stretch the penis over time.

Surgical Treatments:

Surgeries are usually considered as the final option in case of severe penis deformity

• Penile Plication Surgery a procedure that involves shortening of the unaffected side to correct curvature.
• Excision and Grafting involves removing the plaque and replacing with tissue grafts on the defects created.
• Using Penile Prosthesis and Implants in patients with both the cases of Peyronie’s Disease and severe Erectile Dysfunction.

Regardless of the method chosen, it's essential to handle billing and coding with the right urology coding, involving correct and updated CPT codes and adhering to the ICD-10 guidelines. We at Shoreline Medical Billing Company, support healthcare providers by simplifying the complex coding & billing workflows, ensuring compliance, and optimizing revenue.

Urology Coding and Billing Strategies for Peyronie’s Disease:

Primary ICD-10 Code:

• N48.6: Induration penis plastica (Peyronie’s Disease)

  This is the primary diagnostic code used for billing Peyronie’s Disease. It must be clearly documented in the patient’s chart with all supporting clinical evidence.

Other Associated ICD-10 Codes:

• N52.9: Male erectile dysfunction, unspecified
• F52.21: Male erectile disorder
• R68.89 – Other general symptoms and signs

Including these additional codes wherever applicable along with proper supporting medical evidence can increase the revenue efficiently.

Procedure Coding: CPT Codes

Some of the CPT codes associated are

• 54200: Injection of (e.g., collagenase) Xiaflex for Peyronie’s Disease .
• 54235: Injection of corpora cavernosa with pharmacologic agents, Penile injection therapy
• 54400–54416: CPT codes used for penile prosthesis procedures, primarily relating to insertion, removal, and replacement of penile implants.
• 54360: Repair Procedures on the Penis.
• 76872: Under Diagnostic Ultrasound Procedures of the Genitalia

Case Study:

A 52-year-old male visits a urologist with a 6-month history of penile curvature and painful erections. The urologist performs a physical examination and identifies a dorsal plaque he further orders for a penile ultrasound. The diagnosis is confirmed as Peyronie’s Disease. He injects the patient with Xiaflex.

Billing Process and appropriate code usage

• ICD-10 Code: N48.6 for Peyronie’s disease.
• E/M Code: 99204 for new patient with moderate complexity.
• Procedure: 54200 (for injecting with collagenase) & 76872 for ultrasound.
• Prior Authorization: Submitted and approved for collagenase therapy.
• Adding modifier 25 for E/M visit and another distinct service on the same day.

How Shoreline Medical Billing can Support Your Practice?

We handle urology coding for Peyronie’s Disease with

✓ Expert and Trained coders in ICD-10 and urology-specific codes.

✓ Revenue Cycle Management from coding to collections, we optimize your finances.

✓ Always ensuring error-free claims with quick reimbursement.

✓ Following CMS, HIPAA, and payer guidelines for compliance.