Urology Coding Alert
Penile Implant Replacement Falls Under 54410 Even for a Different Type
Question: A patient had three previous two-piece inflatable penile implants; each one had a malfunction in one of the cylinders. This time he opted to replace it with the three-piece implant. Is it better to code the removal with 54415 and the insertion with 54405? The insurer authorized 54410, but I thought that code was for taking out and replacing the same type of implant. Am I just overthinking it and is the 54410 the way to go? West Virginia Subscriber Answer: Your instincts are correct: There is no need to report both 54415 (Removal of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis, without replacement of prosthesis) and 54405 (Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir). Instead, submit only 54410 (Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session). The descriptor does not specify that the implant that was removed and the new one that replaces it must be exactly the same type; in this case they were both multi-components. Include thorough documentation with your claim, but the insurer should still honor the authorization.
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