Urology Coding Alert

Knowing when to use modifiers 52 and 22 is key to proper payment The urologist clearly documents that he removed the patient's penile prosthesis and replaced it with another type of penile prosthesis. The procedure was straightforward, so your coding should be too, right? Not quite. The problem: You won't find one code to represent the removal of one type of prosthesis and its replacement with another type. But don't fret. Our experts will give you the lowdown on how to properly code prosthesis exchanges. Base Coding on Prosthesis Inserted When a urologist removes one type of prosthesis and replaces it with a different type of prosthesis, you're left searching through 10 procedure codes representing penile prosthesis insertion and removal that cover a wide range of penile implant procedures. To choose the proper code for the removal and replacement, you should follow one rule: Base your coding on what type of prosthesis you inserted, not on the type you removed, says Elizabeth Hollingshead, CPC, CMC, corporate billing/coding manager of Northwest Columbus Urology Inc. in Marysville, Ohio. Why? You should choose the code for what your urologist inserted because the insertion portion of the procedure is the most effort- and time-consuming. You'll most likely choose one of the following codes: • 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. Example: During surgery, the urologist removes a semirigid noninflatable penile prosthesis and at the patient's request replaces this semirigid prosthesis with a multicomponent inflatable prosthesis. Code for the placement of the multicomponent inflatable prosthesis using 54405 (Insertion of multicomponent, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir) or 54410-52. Append modifier 52 (Reduced services) to indicate that your urologist also removed a simpler semirigid noninflatable penile prosthesis. "Because I used modifier 52, I would send documentation explaining a noninflatable or self-contained inflatable penile prosthesis was removed, not a multi-component inflatable penile prosthesis," says Martha Guyer, CPC, coding specialist for Piedmont Urological Associates in High Point, N.C. Important: If the urologist is performing the removal and replacement of a multicomponent prosthesis through an infected surgical field, be sure that you use 54411, Hollingshead says. "This code includes the extra work involved in the debridement [...]