How To Use HCPCS Code C1813

HCPCS code C1813 describes a specific type of prosthesis known as a penile inflatable. This code is used to identify and bill for the insertion of an inflatable penile prosthesis, which is a medical device used to treat erectile dysfunction in men. In this article, we will explore the details of HCPCS code C1813, including its official description, procedure, when to use it, billing guidelines, historical information, and Medicare and insurance coverage.

1. What is HCPCS C1813?

HCPCS code C1813 is used to identify the specific prosthesis known as a penile inflatable. This code is assigned to the procedure of inserting an inflatable penile prosthesis to treat erectile dysfunction. It is important to note that this code is specific to the device being used and should not be used for other types of penile prostheses.

2. Official Description

The official description of HCPCS code C1813 is “Prosthesis, penile, inflatable.” The short description provided is “Enteral supp not otherwise c.” This description accurately represents the purpose and nature of the code, indicating that it is used for the insertion of an inflatable penile prosthesis.

3. Procedure

1. The procedure for HCPCS code C1813 involves the surgical insertion of an inflatable penile prosthesis. This procedure is typically performed under general or regional anesthesia.
2. The surgeon makes an incision in the scrotum or lower abdomen to access the corpora cavernosa, which are the two chambers in the penis responsible for erections.
3. The surgeon then carefully inserts the inflatable penile prosthesis into the corpora cavernosa, ensuring proper placement and alignment.
4. The prosthesis consists of two inflatable cylinders, a pump, and a reservoir. The cylinders are placed inside the corpora cavernosa, the pump is implanted in the scrotum, and the reservoir is positioned in the lower abdomen.
5. Once the prosthesis is in place, the surgeon closes the incisions and ensures proper functioning of the device.

4. When to use HCPCS code C1813

HCPCS code C1813 should be used when a healthcare provider performs the surgical insertion of an inflatable penile prosthesis to treat erectile dysfunction. This code is specific to the device being used and should not be used for other types of penile prostheses.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C1813, healthcare providers should ensure that the necessary documentation is included to support the medical necessity of the procedure. This may include clinical notes, diagnostic test results, and any other relevant documentation. It is important to follow the specific billing guidelines set forth by Medicare or other insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C1813 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. As indicated by the action code N, no maintenance actions have been taken for this code. This means that there have been no updates or revisions to the code since its addition.

7. Medicare and Insurance Coverage

HCPCS code C1813 is eligible for coverage by Medicare and other insurance carriers. The pricing indicator code 57 indicates that the service or supply is priced by other carriers. The multiple pricing indicator code A indicates that the code is not applicable as HCPCS priced under one methodology. It is important for healthcare providers to verify coverage and reimbursement policies with each individual payer to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code C1813 should be billed:

1. A 60-year-old male with a history of severe erectile dysfunction undergoes surgical insertion of an inflatable penile prosthesis.
2. A 45-year-old male with diabetes and erectile dysfunction undergoes surgical insertion of an inflatable penile prosthesis after failed attempts with other treatment options.
3. A 70-year-old male with a history of prostate cancer and erectile dysfunction undergoes surgical insertion of an inflatable penile prosthesis following a radical prostatectomy.
4. A 55-year-old male with erectile dysfunction due to Peyronie’s disease undergoes surgical insertion of an inflatable penile prosthesis.
5. A 50-year-old male with erectile dysfunction resulting from a spinal cord injury undergoes surgical insertion of an inflatable penile prosthesis.