Urology Coding Alert

Question: How would you code the removal of a three piece penile prosthesis and the reimplanatation of a new single component malleable penile prosthesis during the same surgical encounter?

Kentucky Subscriber

Answer: When billing for removal and replacement of a penile prosthesis at the same time, choose the combination code for the placement of the particular type of prosthesis you are implanting. In your case, report 54416 (Removal and replacement of non-inflatable [semi-rigid] or inflatable [self-contained] penile prosthesis at the same operative session) and add modifier 22 (Increased procedural service) for the increased work involved in the removal of the previously placed multi component penile prosthesis.

Alternative: As an alternative coding you can bill only the placement of the malleable prosthesis using 54400 (Insertion of penile prosthesis; non-inflatable [semi-rigid]), as some payers will not reimburse for the removal of a prosthesis or implant at the same time as the placement of a new one. Check with your individual payer on the best coding method.