What is the CPT (Current Procedural Terminology) code for irrigation of the corpora cavernosa with saline solution to treat priapism?

CPT Code for Irrigation of Corpora Cavernosa with Saline Solution

The correct CPT code for irrigation of the corpora cavernosa with saline solution to treat priapism is 54220.

Understanding Priapism and Its Management

Priapism is a medical emergency defined as a persistent penile erection lasting more than 4 hours that is unrelated to sexual stimulation. It requires immediate medical attention to prevent permanent erectile dysfunction 1.

Types of Priapism and Initial Management

• Ischemic (low-flow) priapism is the most common type (95% of cases)
• Diagnosis is confirmed through corporal blood gas analysis showing:
  • PO2 ≤30 mmHg
  • PCO2 ≥60 mmHg
  • pH <7.25

Treatment Approach for Ischemic Priapism

The American Urological Association recommends a stepwise approach to treatment 2:

1. First-line treatment: Aspiration of blood from the corpora cavernosa and irrigation with saline
2. Second-line treatment: Intracavernosal injection of phenylephrine (100-500 μg diluted in saline)
3. Third-line treatment: Surgical shunting procedures if medical management fails

CPT Code Selection for Priapism Treatment

The procedure described in the question involves irrigation of the corpora cavernosa with saline solution for a patient with priapism lasting more than two hours. This procedure specifically corresponds to CPT code 54220.

CPT code 54220 is defined as: "Irrigation of corpora cavernosa for priapism" 2. This code specifically covers the procedure of irrigating the corpora cavernosa with saline solution as described in the question.

The other codes listed do not accurately describe the procedure:

• 54230: Injection procedure for corpora cavernosography
• 54231: Dynamic cavernosometry, including intracavernosal injection
• 54235: Injection of corpora cavernosa with pharmacologic agent(s)

Clinical Considerations for Priapism Management

When performing irrigation of the corpora cavernosa:

• A 19-21 gauge butterfly needle is inserted into the lateral aspect of the proximal penis
• Old, dark blood is aspirated from the corpora cavernosa
• Normal saline is used for irrigation 1

The procedure has approximately a 30% resolution rate when used alone, but is often combined with phenylephrine injection for better outcomes 1.

Important Clinical Considerations

• Phenylephrine becomes less effective in priapism lasting more than 48 hours 2
• Patients with priapism lasting more than 18 hours have a significant risk of erectile dysfunction 1
• Permanent erectile dysfunction is highly likely with priapism lasting over 36 hours 1

In summary, CPT code 54220 is the appropriate code for reporting irrigation of the corpora cavernosa with saline solution for priapism treatment.