Introduction: Peyronie’s Disease (ICD-10 N48.6)
Peyronie’s disease (PD) involves the development of fibrous scar tissue beneath penile skin, causing curvature, pain, and functional challenges. Affecting 3-9% of adult males, this connective tissue disorder significantly impacts sexual health and quality of life.
Accurate diagnosis and precise ICD-10 coding (N48.6) are essential for effective treatment and insurance processing. This guide examines PD’s clinical aspects and coding requirements for healthcare professionals.
1. Clinical Foundations of Peyronie’s Disease
Pathophysiology:
- Acute Phase: Inflammation triggers fibroblast proliferation and collagen buildup, causing painful erections (typically 6-18 months)
- Chronic Phase: Plaques stabilize, creating permanent curvature, indentations, or shortening; 30% develop calcification
Risk Factors:
- Genetic predisposition (familial Dupuytren’s contracture in 20-39% of cases)
- Vascular comorbidities (diabetes, hypertension)
- Penile trauma during intercourse
2. Symptom Spectrum
Patients experience:
- Physical Changes: Dorsal curvature (70%), hourglass deformity, length reduction
- Functional Issues: Erectile dysfunction (40-70% of cases), painful intercourse
- Psychological Impact: Depression (48%), relationship strain, sexual avoidance
3. Diagnostic Protocol
Clinical Assessment:
- Physical plaque palpation
- Patient-reported symptom history
Objective Measures:
- Penile Doppler Ultrasound: Visualizes plaque location/size and vascular flow
- Erection Photos: Document curvature severity
- Validated Questionnaires: PDQ (Peyronie’s Disease Questionnaire), IIEF-5 (erectile function)
4. ICD-10 Coding: N48.6 Essentials
Code Structure:
- Primary Code: N48.6 (Induratio penis plastica)
- 5th Digit Specification:
- N48.61: Right side
- N48.62: Left side
- N48.69: Unspecified laterality
Documentation Requirements:
- Plaque location/size
- Curvature degree/direction
- Associated conditions (e.g., ED: N52.9)
Common Pitfalls:
- Using unspecified N48.6 without laterality
- Confusing with congenital curvature (Q55.62)
5. Treatment Approaches
Non-Surgical Options:
| Treatment | Protocol | Efficacy |
|---|---|---|
| Xiaflex® Injections | 2-4 cycles (FDA-approved) | 34% curvature reduction |
| Traction Devices | 2-8 hrs/day for 6 months | Length improvement |
| Verapamil Gel | Daily topical application | Limited evidence |
Surgical Solutions:
- Plication: For mild curvature (<60°) with preserved erectile function
- Grafting: Complex reconstruction for severe deformity
- Implants: With modeling for patients with concurrent ED
6. Coding for Reimbursement
Critical Elements:
- Link N48.6 to all PD-related services:
- Ultrasound (CPT® 93980)
- Xiaflex injections (CPT® 54235)
- Surgical correction (CPT® 54400-54405)
Compliance Tips:
- Document curvature >30° for surgical pre-authorization
- Report comorbidities separately (e.g., diabetes: E11.9)
- Avoid billing for experimental therapies (e.g., shockwave treatment)
7. Emerging Developments
- ICD-11 Transition: Future classification under “Disorders of the Penis” (8C70.1)
- Novel Therapies: Stem cell applications and anti-fibrotic biologics in trials
- Patient Registries: Improving epidemiological data through standardized coding
