AUA-Recommendations-on-Coding-for-Xiaflex
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January 7, 2014
The essential
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Volume XXI, Number 1
Table of Contents
Summary of the 2014 Medicare
Physician Fee Schedule Final
Rule
Practices Prepare for Open
Payments Implementation
Senate Makes Last Minute
Votes Before Session Adjourns
For the Record: GAO Report:
HHS Should Do More To
Improve Qualified Clinical
Data Registry Use
Registration Closing Soon: Sign
up for the QI Summit Now
Coding for New Medical
Treatment of Peyronie’s
Disease
AUA Recommendations on
Coding for Xiaflex
Coding Corner: New Codes for
Prostate Pathology Services
Contractors and Trading
Partners to Test ICD‐10
Starting March 3
Register for the CMS Webinar
on Quality Resource Use
Reports (QRURs)
Implementation of Ordering
and Referring Denial Edits
AUA Recommendations on Coding for Xiaflex
Procedure
Code Descriptor
CPT Code(s)
RVUs
Visit 1
Induce erection
Injection of corpora cavernosa
with pharmacologic agent(s) (eg,
papaverine, phentolamine)
54235
2.67
This procedure is performed to determine where
the injection of Xiaflex should be administered on
the penis.
Detumese
Therapeutic, prophylactic, or
diagnostic injection (specify
substance or drug); subcutaneous
or intramuscular
96372
0.71
If the tumesence does not detumese on its own,
then an injection of a medication to
pharmacologically detumese the penis is
necessary. This code covers the injection of the
medication.
Anesthetic
Not billable
An injection of a numbing agent is included in all
procedures. This code does not represent an
injection of numbing agent but a nerve block into
the nerve bundles outside of the prostate. Most
urologists will not perform this procedure.
Xiaflex
Medication code
J0775
Injection for
Peyronie disease
Injection procedure for Peyronie
disease;
54200
3.21
The injection procedure has a 10‐day global
period. In order to receive reimbursement for the
second 54200 injection, the initial operative report
must include documentation that an additional
injection procedure will be required in the next 24‐
72 hours. The modifier 58 staged procedure must
be appended to the second 54200 procedure.
Visit 2
Xiaflex
Medication code
J0775
Injection for
Peyronie disease
Injection procedure for Peyronie
disease;
54200 ‐ 58
3.21
**Modifier to be used for injection visit 2 ‐ Since
injection for peyronie disease has a 10 day global
period, the 58 staged procedure modifier should be
used.
Visit 3
3/15/2017
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Modeling Procedure
There is one Evaluation and
Management (E&M) Service CPT
code 99212 included in the 10‐day
global period of 52400. A
separate E&M visit cannot be
billed during the global period.
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