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Vacuum Erection Devices (L7900)—Documentation Requirements

Vacuum erection devices (L7900) are eligible for coverage under the prosthetic device benefit which stipulates that the device must be used to replace all or part of an internal body organ. In addition to the statutory requirements, the general documentation requirements as described in Chapter 8 of the Jurisdiction B DME MAC Supplier Manual apply: 

“For any DMEPOS item to be covered by Medicare, the patient’s medical record must contain sufficient documentation of the patient’s medical condition to substantiate the necessity for the type and quantity of items ordered and for the frequency of use or replacement (if applicable). The information should include the patient’s diagnosis and other pertinent information including, but not limited to, duration of the patient’s condition, clinical course (worsening or improvement), prognosis, nature and extent of functional limitation, other therapeutic interventions and results, past experience with related items, etc. If an item requires a CMN, it is recommended that a copy of the completed CMN be kept in the patient’s record. However, neither a physician’s order, nor a CMN, nor a supplier-prepared statement, nor a physician attestation by itself provides sufficient documentation of medical necessity, even though it is signed by the treating physician. There must be clinical information in the patient’s medical record which supports the medical necessity for the item and substantiates the answers on the CMN (if applicable) or information on a supplier-prepared statement or physician attestation (if applicable).” 

Often claims for these devices do not have diagnostic information that relates to organic impotence. For patients receiving a vacuum erection device, the physician evaluation would generally include a history and physical examination focused on defining the cause of the erectile dysfunction/impotence and treatment of any co-morbid conditions that may impact sexual function. This is important to assure that specifically treatable conditions are identified before ordering a vacuum erection device. Documentation of this evaluation, conducted prior to the date of service on the claim, must be available to the DME MAC upon request. For claims that meet these documentation requirements, in addition to the ICD-9 diagnosis code for organic impotence (607.84), National Government Services recommends that providers also include a secondary diagnosis to identify the cause of the impotence.

Vacuum Erection Devices (L7900)—Documentation Requirements
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