Fun with Medicare & CPT® code 51840 - Gender specific??

Hoping somebody has dealt with this or a similar issue before.

Medicare (NORIDIAN) is denying CPT® code 51840 (anterior vesicourethropexy) performed on a male stating this code is gender specific to females only.

Our CPT® book actually states: this code is generally performed on females. However, nothing in this code denotes gender.

Noridian is denying it and they state their CPT® code book states "this CPT® code applies strictly to females".

Our practice has been billing Medicare for this code for years. We never had a problem when our contractor was Palmetto but now that it's Noridian we are having all kinds of issues of this type.

Does anyone have a CPT® denifition of this code that states it is strictly a female code?

Thanks in advance.

re: Fun with Medicare & CPT® code 51840 - Gender specific??

Yes, that is female specific.

re: Fun with Medicare & CPT® code 51840 - Gender specific??

Can you please give me a CPT® book you concluded that this code is gender specific from? Because, as I said, our CPT® book says, in black and white, this code is not gender specific.

re: Fun with Medicare & CPT® code 51840 - Gender specific??

I'm with you - this code isn't gender specific according to the AMA. It's used to treat urinary stress incontinence, which predominantly females suffer from, but males can also have urinary stress incontinence. I would contact the AUA to see if they can offer any insight or have additional material you can submit with your appeal.

re: Fun with Medicare & CPT® code 51840 - Gender specific??

Thank you! I will do that.

re: Fun with Medicare & CPT® code 51840 - Gender specific??

Just wanted to update this - I appealed Medicare's denial of this CPT® code and my appeal was successful. I had this issue on 7 male patients. Noridian is a pain....