Summary & Overview
CPT 00938: Anesthesia for Penile Prosthesis Insertion, Perineal Approach
CPT code 00938 denotes anesthesia services for penile prosthesis insertion via a perineal approach, an operative treatment for erectile dysfunction in men. This code captures the anesthetic management specific to a urologic implant procedure performed through the perineum and is used by providers and payers to classify perioperative anesthesia resources and complexity. Nationally, accurate coding of these services affects claims adjudication, payment consistency, and clinical documentation for male genital surgical anesthesia.
Key payers covered in this summary include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 00938, how it relates to other anesthesia codes for male genital procedures, typical sites of service, and which diagnoses commonly support medical necessity for the procedure. The publication also outlines common modifiers and related anesthesia and urology procedure codes for coding workflows, and highlights benchmarking and policy considerations relevant to national payer practices.
This piece is intended for coding professionals, anesthesiology and urology clinicians involved in perioperative documentation, and revenue cycle staff seeking clarity on classification and claims handling for anesthesia tied to penile prosthesis insertion.
Billing Code Overview
CPT code 00938 describes anesthesia services provided for penile prosthesis insertion performed through the perineum. The procedure is performed to treat erectile dysfunction in men. The service type is anesthesia for a surgical implant procedure on the male genitalia. The typical site of service is an operating room or ambulatory surgical center where urologic surgical procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with a history of erectile dysfunction refractory to oral therapy presents for elective implantation of an inflatable penile prosthesis via a perineal approach. The patient has failed conservative measures and has elected surgical management after counseling. Preoperative evaluation in the ambulatory surgical center includes history, focused physical exam, medication reconciliation, and anesthesia assessment. The anesthesiologist documents airway, comorbidities (for example, controlled hypertension and type 2 diabetes), and ASA classification (commonly P2 or P3). On the day of surgery, regional or general anesthesia is administered based on anesthesiologist and surgeon decision; monitoring includes standard ASA monitors, intravenous access, and perioperative antibiotics per urology protocol. The procedure is performed through a perineal incision for placement of the penile prosthesis. Postoperative recovery occurs in PACU with pain control, device education, and discharge planning to home or overnight observation depending on intraoperative events and comorbidities. Billing uses anesthesia code 00938 for anesthesia services specific to penile prosthesis insertion via perineum.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
23 |