How To Use CPT Code 54235

CPT 54235 describes the injection of pharmacologic agents into the corpora cavernosa of the penis to treat patients with erectile dysfunction. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 54235?

CPT 54235 is used to describe the injection of pharmacologic agents, such as papaverine, phentolamine, or prostaglandin E1, into the corpora cavernosa of the penis. This procedure is performed to treat patients with erectile dysfunction, helping them regain an erection.

2. Official Description

The official description of CPT code 54235 is: ‘Injection of corpora cavernosa with pharmacologic agent(s) (eg, papaverine, phentolamine).’ There are no additional notes or modifiers specified for this code.

3. Procedure

1. In this procedure, the healthcare provider first withdraws some blood from the corpora cavernosa, which is the sponge-like tissue in the penile shaft region.
2. Next, the provider injects a pharmacologic agent, such as papaverine, phentolamine, or prostaglandin E1, into the corpora cavernosa.
3. This injection helps to relieve muscle tightness, dilate blood vessels, and improve blood flow to the penis, resulting in an erection.
4. The procedure is performed to assess the patient’s reaction to the drugs or to titrate the proper dosage for future treatments.

4. Qualifying circumstances

CPT 54235 is used for patients with erectile dysfunction who require the injection of pharmacologic agents into the corpora cavernosa of the penis. The procedure is typically performed by a healthcare provider to help patients regain erectile function. It is important to note that this code should not be reported if the injection is self-administered by the patient at home.

5. When to use CPT code 54235

CPT code 54235 should be used when a healthcare provider performs the injection of pharmacologic agents into the corpora cavernosa of the penis to treat erectile dysfunction. It is important to ensure that the procedure is performed in the office setting and not self-administered by the patient at home.

6. Documentation requirements

To support a claim for CPT 54235, the healthcare provider must document the following information:

• Patient’s diagnosis of erectile dysfunction
• Specific pharmacologic agent(s) used for the injection
• Date of the procedure
• Details of the injection technique and dosage administered
• Any adverse reactions or complications
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 54235, ensure that the procedure is performed by a qualified healthcare provider and that it is not self-administered by the patient. It is important to check payer policies regarding separate payment for the drugs involved in the procedure. Additionally, it is recommended to report CPT 54235 only once to assess the patient’s reaction to the drugs or to titrate the proper dosage.

8. Historical information

CPT 54235 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider performs an injection of papaverine into the corpora cavernosa of the penis to treat a patient with erectile dysfunction.
2. Phentolamine is injected into the corpora cavernosa by a healthcare provider to help a patient regain erectile function.
3. A patient with erectile dysfunction receives an injection of prostaglandin E1 into the corpora cavernosa of the penis to improve blood flow and achieve an erection.
4. A healthcare provider administers a combination of papaverine and phentolamine injections to a patient with erectile dysfunction, aiming to enhance the effectiveness of the treatment.
5. During a follow-up visit, a healthcare provider adjusts the dosage of the pharmacologic agent injected into the corpora cavernosa to optimize the patient’s response and improve erectile function.