Urology Coding Alert

Question: How should I code for an insertion of a non-inflatable semi-rigid penile prosthesis for erectile dysfunction, when the urologist had to terminate the procedure because of a urethral tear requiring repair?

New Mexico Subscriber

Answer: The coding for this scenario depends in part on how much of the insertion procedure your urologist was actually able to perform and what type of urethral repair he did.
 
For the corporal dilation and rod insertion portion of the procedure, you should report 54400 (Insertion of penile prosthesis; non-inflatable [semi-rigid]). Append modifier 52 (Reduced services), which indicates a reduced service because of the early termination of the procedure due to the urethral injury. The ICD-9 diagnosis code you should use is 607.84 (Impotence of organic origin) for the primary impotence.
 
Depending on the repair that the urologist performed, you should also report either 53410 (Urethroplasty, one-stage reconstruction of male anterior urethra) or 53505 (Urethrorrhaphy, suture of urethral wound or injury; penile). Append modifier 51 (Multiple procedures) for non-Medicare carriers to indicate that the urologist performed more than one procedure. Medicare will append modifier 51 on its own.
 
You should use 867.0 (Injury to pelvic organs; bladder and urethra, without mention of open wound into cavity) as the diagnosis code with the repair procedure code.
 
Reasoning: Although the urethral repair resulted from a complication at the time of surgery, because the urologist had to spend significant time and effort for its repair, this also becomes a billable service at the time of the reduced primary procedure.