# Priapism surgical codes



## Jessim929 (Mar 5, 2019)

Hi all - 

I keep tripping myself up with the surgical codes for priapism. Probably because nobody "cookie cutter" dictates them.  

ANYWAY. 

The way I differentiate them is 54420 and 54430 is how deep they go. (54430 is into the spongy tissue) 54435 is based on how they actually go in - with the biopsy needle or punch vs. the scalpel. 

Am I in the right neighborhood in how I differentiate them or am I WAY off base? 

Any help or input is appreciated!!

Thank you!!


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## drewvinson23 (Mar 14, 2019)

I believe the difference between these two codes is the location of where the shunt drains to.

Per Optum360 Coding Companion for Urology/Nephrology:  "In 54420, the physician treats priapism, an abnormally sustained erection, by creating a shunt for the diversion of blood from the penis to the femoral vein."

From the same book, "In 54430 and 54435, the physician treats priapism by creating a shunt for the diversion of blood from one region of the penis to an adjacent region."

So, in 54420, the shunt is created between the corpus cavernosa and the saphenous vein.  In 54430, the shunt is created between the corpus cavernosa and the corpora spongiosum.  You could probably delineate these in the operative note by seeing if the physician mentions shunting into the vein or not.

Hope this helps,

Drew Vinson
CPC
NW Urology


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## Jessim929 (Mar 19, 2019)

It kinda does help! Thank you!

So, if there's no mention of the vein, it's most likely NOT a 54420?


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## drewvinson23 (Mar 22, 2019)

That's how I would interpret it.  It would seem unlikely to me that the doctor would place a shunt into the vein without mentioning it in the operative note.

As always, if you have questions about the operative report you should query your provider for clarification.

Sincerely,

Drew Vinson
CPC
NW Urology


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