CHAPTER 12 Male Reproductive Health Male Infertility Erectile Dysfunction Peyronie’s Disease Vasectomy Undescended Testes 406 | Urologic Diseases In America Table 12-1. Codes used in the diagnosis and management of male reproductive health Erectile Dysfunction Males 18 years or older with one or more of the following: ICD-9 diagnosis codes 302.7 Psychosexual dysfunction 302.70 Psychosexual dysfunction, unspecified 302.71 Psychosexual dysfunction with inhibited sexual desire 302.72 Psychosexual dysfunction with inhibited sexual excitement 302.74 Psychosexual dysfunction with inhibited male orgasm 607.82 Vascular disorders of penis 607.84 Impotence of organic origin 607.89 Other specified disorders of penis 607.9 Unspecified disorder of penis ICD-9 procedure codes 64.94 Fitting of external prosthesis of penis 64.95 Insertion or replacement of non-inflatable penile prosthesis 64.96 Removal of internal prosthesis of penis 64.97 Insertion or replacement of inflatable penile prosthesis CPT procedure codes 37788 Penile revascularization, artery, with or without vein graft 37790 Penile venous occlusive procedure 54115 Removal foreign body from deep penile tissue (eg, plastic implant) 54230 Injection procedure for corpora cavernosography 54231 Dynamic cavernosometry, including intracavernosal injection of vasoactive drugs (eg, papaverine, phentolamine) 54235 Injection of corpora cavernosa with pharmacologic agent(s) (eg, papaverine, phentolamine) 54240 Penile plethysmography 54250 Nocturnal penile tumescence and/or rigidity test 54400 Insertion of penile prosthesis; non-inflatable (semi-rigid) 54401 Insertion of penile prosthesis; inflatable (self-contained) 54405 Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir 54406 Removal of all components of a multi-component, inflatable penile prosthesis without replacement of prosthesis 54408 Repair of component(s) of a multi-component, inflatable penile prosthesis 54410 Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session 54411 Removal and replacement of all components of a multi-component, inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue 54415 Removal of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis, without replacement of prosthesis 54416 Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session 54417 Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue Peyronie's Disease Males 18 years or older with one or more of the following: ICD-9 diagnosis codes 607.81 Balanitis xerotica obliterans, induratio penis plastica ICD-9 procedure codes a 64.4 Repair and plastic operation on penis a 64.42 Release of chordee 64.49 Other repair of penis CPT procedure codes 54110 Excision of penile plaque (Peyronie's disease) 54111 Excision of penile plaque (Peyronie's disease); with graft to 5 cm in length Continued on next page. Male Reproductive Health | 407 Table 12-1 (continued). Codes used in the diagnosis and management of male reproductive health 54112 Excision of penile plaque (Peyronie's disease); with graft greater than 5 cm in length 54200 Injection procedure for Peyronie's disease 54205 Injection procedure for Peyronie's disease; with surgical exposure of plaque 54360 Plastic operation on penis to correct angulation Infertility Males 18 years or older with one or more of the following: ICD-9 diagnosis codes 456.4 Scrotal varices 606 Male infertility 606.0 Azoospermia 606.1 Oligospermia 606.8 Infertility due to extratesticular causes 606.9 Male infertility, unspecified CPT procedure codes 52347 Cystourethroscopy with transurethral resection or incision of ejaculatory ducts 54500 Biopsy of testis, needle (separate procedure) 54505 Biopsy of testis, incisional (separate procedure) 54900 Epididymovasostomy, anastomosis of epididymis to vas deferens; unilateral 54901 Epididymovasostomy, anastomosis of epididymis to vas deferens; bilateral 55200 Vasotomy, cannulization with or without incision of vas, unilateral or bilateral (separate procedure) 55300 Vasotomy for vasograms, seminal vesiculograms, or epididymograms, unilateral or bilateral 55400 Vasovasostomy, vasovasorrhaphy 55530 Excision of varicocele or ligation of spermatic veins for varicocele; (separate procedure) 55535 Excision of varicocele or ligation of spermatic veins for varicocele; abdominal approach 55540 Excision of varicocele or ligation of spermatic veins for varicocele; with hernia repair 55550 Laparoscopy, surgical, with ligation of spermatic veins for varicocele 55870 Electroejaculation 74440 Vasography, vesiculography, or epididymography, radiological supervision and interpretation Undescended Testes Males with one or more of the following: ICD-9 diagnosis codes 752.5 Undescended and retractile testis 752.51 Undescended testis 752.52 Retractile testis ICD-9 procedure codes b 62.5 Orchiopexy b 63.53 Transplantation of spermatic cord CPT procedure codes 54550 Exploration for undescended testis (inguinal or scrotal area) 54560 Exploration for undescended testis with abdominal exploration 54640 Orchiopexy, inguinal approach, with or without hernia repair 54650 Orchiopexy, abdominal approach, for intra-abdominal testis (eg, Fowler-Stephens) 54690 Laparoscopy, surgical; orchiectomy 54692 Laparoscopy, surgical; orchiopexy for intra-abdominal testis 54699 Unlisted laparoscopy procedure, testis aMust occur with diagnosis of 607.84 (impotence of organic origin) or 607.89 (other specified disorders of penis). bMust occur with diagnosis of 550.XX or 752.XX. 408 | Urologic Diseases In America Multiple factors, Multiple factors, Multiple factors, Multiple factors, female + male female only 10.9% female + male female only 10.9% 17.8% 17.8% Unexplained cause Unexplained cause 12.8% 12.8% Tubal factor 8.4% Tubal factor 8.4% Other causes 8.0% Other causes 8.0% Ovulatory Ovulatory dysfunction 6.7% dysfunction 6.7% Diminished ovarian Diminished ovarian reserve 11.0% Male factor 18.4% reserve 11.0% Male factor 18.4% Endometriosis Endometriosis 4.6% 4.6% Uterine factor 1.4% Uterine factor 1.4% Figure 12-1. Diagnoses among couples who had ART cycles using fresh non-donor eggs or embryos, 2008 Figure 12-1. Diagnoses among couples who had ART cycles using fresh non-donor eggs or embryos, 2008 SOURCE: Adapted from Centers for Disease Control and Prevention, 2008 Assisted Reproductive Technology (ART) Report. SOURCE: Adapted from Centers for Disease Control and Prevention, 2008 Assisted Reproductive Technology (ART) Report. No maleNo facto maler factor MaleMale factor factor infertilityinfertility infertilityinfertility 52.9% 52.9% 47.1%47.1% Figure 12-2. Use of ICSI in fresh non-donor cycles among couples with and without diagnoses of male factor infertility, 2008 Figure 12-2. Use of ICSI in fresh non-donor cycles among ICSI: Intracystoplasmic sperm injection. couplesNOTE: with Based onand 67,258 without cycles that used diagnoses IVF with ICSI. of male factorSOURCE: infertility, Adapted from 2008 Center s for Disease Control and Prevention, 2008 Assisted Reproductive Technology (ART) Report. ICSI: Intracystoplasmic sperm injection. NOTE: Based on 67,258 cycles that used IVF with ICSI. SOURCE: Adapted from Centers for Disease Control and Prevention, 2008 Assisted Reproductive Technology (ART) Report. Male Reproductive Health | 409 50.0%50.0% 45.6% 46.2% 45.6% 46.2% 45.0% 45.0% 40.0%40.0% 36.4% 35.3% 36.4% 35.3% 35.0% 35.0% 30.0% 30.0% 27.6% Percent 26.8% 27.6% Percent 26.8% IVFIVF with with ICSI ICSI 25.0%25.0% IVFIVF without without ICSI ICSI 20.0%20.0% 16.0% 15.5% 16.0% 15.5% 15.0% 15.0% 10.0%10.0% 7.2% 7.6% 7.2% 7.6% 3.9% 5.0%5.0% 3.9% 2.1% 2.1% 0.0%0.0% <35 35-37 38-40 41-42 43-44 >44 <35 35-37 38-40 41-42 43-44 >44 AgeAge (years) (years) FigureFigure 12-3. 12-3. PercentagesPercentages of of retrievals retrievals that that resulted resulted in in live live births births among among couples couples dia diagnosedgnosed with with male male factor factor infertility infertility who who u sed IVFused with IVF ICSI, with compared ICSI, compared with couples with couples not diagnosed not diagnosed with male with factor male factorinfertility infertility who used who IVF used without IVF without ICSI, by ICSI, age of woman,by age of2008 woman, 2008 ICSI:ICSI: Intracystoplasmic Intracystoplasmic sperm sperm injection. injection. NOTE:NOTE: Cycles Cycles using using donor donor sperm sperm and and cycles cycles using using GIFT GIFT or or ZIFT ZIFT are are excluded. excluded. SOURCE:SOURCE: Adapted Adapted from from Centers Centers for for Dise Diseasease Control Control and and Prevention, Prevention, 2008 2008 Assisted Assisted Reproductive Reproductive Technology Technology (ART) (ART) Report. Report. 410 | Urologic Diseases In America Table 12-2. Inpatient stays by privately insured individuals for male infertility listed as primary diagnosis, rate,a age-adjusted rateb 2002 (N=76) 2003 (N=86) 2004 (N=92) 2005 (N=74) 2006 (N=63) Age- Age- Age- Age- Age- Rate Adjusted Rate Adjusted Rate Adjusted Rate Adjusted Rate Adjusted Rate Rate Rate Rate Rate Total 1.8 1.4 1.8 1.0 1.9 0.8 1.4 1.2 1.2 1.0 Age 18-24 1.3♦ 1.1♦ 1.9♦ 0.4♦ 1.6♦ ♦ ♦ 25-34 3.0*♦ 3.7* 3.5* 2.5 1.4 ♦