Urology Coding Alert

Hint: Make sure you know whether a non-inflatable or inflatable prosthesis was inserted.

If your urologist performs penile prosthesis implants to treat erectile dysfunction in patients, you will need to carefully read the medical documentation to determine the type of prosthesis he inserted, as well as the surgical approach.

Read on to learn more.

Tip 1: Focus on These Codes for Penile Prosthesis Insertion

If your urologist performs a penile prosthesis insertion, you have several codes to look to. They are as follows:

• 54400 (Insertion of penile prosthesis; non-inflatable (semi-rigid))
• 54401 (Insertion of penile prosthesis; inflatable (self-contained))
• 54405 (Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir)

Don’t miss: As you can tell from the code descriptors, you should report 54400 if your urologist inserts a non-inflatable/semi-rigid prosthesis. With this prosthesis, the penis will always be slightly rigid or firm. The penis can be bent away from the body for sexual activity and bent toward the body at other times.

On the other hand, when your urologist inserts an inflatable or self-contained prosthesis, you should report 54401. This means the prosthesis can be inflated to create an erection and deflated at other times.

If your urologist inserts a multi-component, inflatable prosthesis, you should report 54405. This prosthesis creates the most natural erection because of its multiple parts, but also is the most extensive surgical procedure with the most potential risks.

Coding tip: Many multi-component implants have three pieces. But, if your urologist implants a two-piece prosthesis, you will still report 54405 as this is considered a multiple component prosthesis.

Tip 2: Urologist Removed Prosthesis Without Replacement? Do This

In some cases, your urologist may need to remove a penile prosthesis because the patient has an infection early or postoperative pain, scar tissue formation, or mechanical implant failure. You will look to the following codes for a penile prosthesis removal without replacement:

• 54406 (Removal of all components of a multi-component, inflatable penile prosthesis without replacement of prosthesis)
• 54415 (Removal of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis, without replacement of prosthesis)Don’t miss: You should check the medical documentation to see what type of prosthesis your urologist removed to choose the appropriate code between 54406 and 54415.

Tip 3: Rely on These Options if Urologist Removes Prosthesis and Replaces it

On the other hand, if your urologist removes the prosthesis and replaces it with another one, then you shall look to the following codes:

• 54410 (Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session)
• 54411 (Removal and replacement of all components of a multi-component inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue). Note: If your urologist removes some of the prosthesis components but not all of them, you should report code 54411 with 52 (Reduced services) appended.
• 54416 (Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session)
• 54417 (Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue)

Remember: When your urologist removes one type of prosthesis and replaces it with another type of prosthesis, always bill for the type of prosthesis that he newly implanted, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology State University of New York, Stony Brook, New York. When your urologist removes a multiple component prosthesis and replaces it with a non-inflatable semi-rigid prosthesis, report 54416 and append modifier 22 (Increased procedural services) to indicate the extra work he performed to remove the multiple component prosthesis.

When your urologist removes a semi-rigid prosthesis and replaces it with a multiple component prosthesis, bill 54411 and append modifier 52 (Reduced services) to indicate the reduced work for the removal of the semi-rigid prosthesis, Ferragamo adds.

Tip 4: Remember Modifier 53 in This Case

In some cases, your urologist may encounter a complication while he is inserting a penile prosthesis. For example, your urologist schedules a insertion of a non-inflatable, semi-rigid penile prosthesis, but he has to discontinue the procedure because he finds a urethral tear that he needs to repair. You should report 54400 and append modifier 53 (Discontinued procedure for the well-being of the patient) because he had to terminate the full procedure due to the urethral injury.

Since your urologist also had to repair the urethral injury, which required a significant amount of time and effort during the terminated primary procedure, you should also report 53505 (Urethrorrhaphy, suture of urethral wound or injury; penile) for the repair.