• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Penile prosthesis

Create Wiki Sort by votes
J

jcrahan13

Guest
Messages
31
Best answers
0
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?
 
0
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.
 
0
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.
 
You must log in or register to reply here.
Top