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Penile Prosthesis Coding (CPT)

image of a penile prosthesis
3-piece, inflatable penile prosthesis for the treatment of erectile dysfunction

When a male experiences erectile dysfunction, and it becomes a problem, there is treatment for it. Take the penile prosthesis coding challenge below to see how well you know your CPT coding guidelines related to penile implantation surgery.

The Coding Challenge

Question:

A 67-year-old male presents with erectile dysfunction due to his ten-year history of Atenolol for hypertension. After attempting various treatment options with no success, the patient undergoes penile prosthesis surgery. The urologist inserts the fluid-filled reservoir under the abdominal wall, a pump and release valve inside the scrotum, and two inflatable cylinders inside the penis. Assign for CPT. 

A. 54401
B. 54410
C. 54408
D. 54405

Answer:

D. 54405

Erectile Dysfunction and Penile Prosthesis Surgery

Erectile dysfunction (ED), sometimes called impotence, is a common male disorder, according to the Mayo Clinic. It is the inability to achieve and/or maintain penile erection sufficient for satisfactory sexual performance. When ED becomes a problem, there are treatments available, with penile implants being one of them. However, this surgical procedure should be used as a last resort.

According to  the National Institute of Diabetes and Digestive and Kidney Diseases, there are various causes of ED. They include certain diseases and conditions, medications, psychological or emotional problems, and certain health-related factors and behaviors. 

In this coding challenge, the patient’s erectile dysfunction was caused by his long history of Atenolol (brand name Tenormin), a medication used to treat hypertension. The procedure performed is an insertion of a multiple-component, inflatable device. It consists of a reservoir, pump and release valve, and two inflatable cylinders. 

Types of Penile Implants

Surgical penile prostheses come in inflatable and non-inflatable types. There is a three-piece (multi-component) inflatable prosthesis and a two-piece (self-contained) prosthesis. The non-inflatable prosthesis is a malleable or semi-rigid model.

Multiple-Component, Inflatable Penile Implant

The multiple-component, inflatable penile implant is a device that sits inside the male’s penis to allow him to have a natural appearing erection. The reservoir in the abdomen holds the saline solution when it is not in the penis. The two cylinders sit inside the penis, and the pump sits in the scrotum between the testicles. When the male wants an erection, he squeezes on the pump until the saline in the reservoir transfers to the cylinders in the penis to create an erection.

Possible risks are associated with this type of surgery, which may necessitate a repair or removal and/or replacement of the device.

CPT Coding for Penile Prosthesis

Penile prosthesis CPT codes (54400-54417) are categorized as to the type of penile prosthesis (non-inflatable or inflatable) and the type of service (insertion, repair, removal, and/or replacement). Inflatable prosthesis codes are further categorized as to whether it is a self-contained (two-piece) or multi-component (three-piece) implant. Still, other codes are categorized according to the circumstances of the service.

Locate and Verify

In the CPT Index, look up Prosthesis/penile/insertion, 54400-54405. We can then go to the Tabular List and verify the correct code as: 

54405, Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir

image of cpt 54405, insertion of multiple-components, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir with list of 3 parts of the implant

When reporting for the penile device itself, you will also want to assign HCPCS supply code C1813 (Prosthesis, penile, inflatable).

Incorrect Answers

A, B, and C are incorrect.

A. 54401. This code refers to insertion of penile prosthesis; inflatable (self-contained).

B. 54410. This code refers to removal and replacement of all components of a multi-component, inflatable penile prosthesis at the same operative session.

C. 54408. This code refers to repair of component(s) of a multi-component, inflatable penile prosthesis.

How’d you do? Please don’t hesitate to share your thoughts below.

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