Wiki Penile prosthesis

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jcrahan13

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Does anyone know the correct codes for a penile prosthesis surgery when a Nesbit procedure is also performed? Can you code 54360 with the 54405 code or is this procedure considered included in the implant procedure 54405?
 
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I don't see any edits between the 2. My doctors perform 54405 all the time but do not perform a Nesbit with it, so if they did perform the Nesbit I suppose I would code that as well.
 
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Our doctor performs 54405 and 54360 together. On a rare occasion, we receive a denial based on MARS, Medical Audit & Review Solutions, which their source is National Institute for Health and Care Excellence stating 54360 is included in 54405 with findings: correction of penis angulation or epispadias 54360 is included in insertion of a penile prosthesis 54405 when the correction is made during surgery using manual modeling techniques. My suggestion is to run the CCI edit on Medicare (no edits evoked) and payor CCI edit (hopefully no edits revoked) and use those to appeal a denial for bundled.
 
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