Urology Coding Alert

When it comes to penile prosthesis codes, you won't find any to represent the removal of one type of prosthesis and its replacement with another type modifiers    -52 and -22 may be just what you need to get paid for your urologist's unusual removal-and-replacement procedures.

 CPT includes 10 penile prosthesis insertion and removal codes that cover a wide range of penile implant procedures, but they forgot one: a code to represent the removal of one type of prosthesis and the replacement with another type.

 For example, a patient presents for the removal of an infected noninflatable penile prosthesis, and after the removal procedure the urologist replaces the infected prosthesis with a multicomponent inflatable one. But there is no code to represent this procedure, says Judy Pate, CPC, coding specialist for the department of urology at Louisiana State University in Shreveport.

 When you remove one type of prosthesis and replace it with a prosthesis of a different type, there is a rule of thumb: Base your coding on what type of prosthesis you inserted, not on the type you removed. The following CPT codes are available:
  54410 Removal and replacement of all component(s) of a multicomponent   inflatable penile prosthesis at the same operative session
  54411 Removal and replacement of all components of a multicomponent   inflatable penile prosthesis through an infected field at the same operative session,   including irrigation and debridement of infected tissue
  &54416 Removal and replacement of noninflatable (semirigid) or inflatable   (self-contained) penile prosthesis at the same operative session
  &54417 Removal and replacement of noninflatable (semirigid) or inflatable   (self-contained) penile prosthesis through an infected field at the same operative   session, including irrigation and debridement of infected tissue
  
 As a general rule, you choose the code for what was inserted because the insertion portion of the procedure is the most effort- and time-consuming, says John J. Mulcahy, MD, MS, PhD, FACS, professor of urology at Indiana University School of Medicine in Indianapolis.

 Let's say a urologist removes a multicomponent prosthesis and replaces it with a semirigid one. You should report the code for the removal and replacement of a semi-rigid prosthesis to reflect the type of prosthesis that was inserted, then you should append modifier -22 (Unusual procedural services) to account for the additional work and time spent removing the pump and reservoir: 54416-22, Mulcahy instructs coders. "You are putting in the simple [prosthesis] but removing extra parts that take about 25 percent more time," which warrants the use of modifier -22 with the proper documentation, he adds.

 On the other hand, suppose a patient has a semirigid rod implanted by one urologist and one year later he decides to have the rod replaced with an updated, enhanced multiple-component prosthesis by another urologist. Rods work, Mulcahy says, [...]