CPT Code for Removal and Replacement of Penile Prosthesis
The correct CPT code for removal of a malfunctioning AMS 700 inflatable penile prosthesis and all components and implantation of an inflatable multi-component AMS Tambocor in the same surgery session is 54411.
Understanding CPT Code Selection for Penile Prosthesis Procedures
When coding for penile prosthesis procedures, it's important to understand the distinctions between different CPT codes:
- 54406: Removal of all components of a multi-component, inflatable penile prosthesis without replacement
- 54408: Repair of component(s) of a multi-component, inflatable penile prosthesis
- 54410: Removal and replacement of all components of a multi-component, inflatable penile prosthesis at the same operative session
- 54411: Removal and replacement of all components of a multi-component, inflatable penile prosthesis through an infected field at the same operative session
Key Factors in This Case
The scenario describes:
- Removal of a malfunctioning AMS 700 inflatable penile prosthesis and all components
- Implantation of a new inflatable multi-component AMS Tambocor prosthesis
- Both procedures performed in the same surgery session
While code 54410 might initially seem appropriate for removal and replacement of all components in the same session, the key distinction is that this case involves a malfunctioning prosthesis.
Why 54411 is the Correct Code
The malfunctioning status of the original prosthesis indicates a potential infection or complication requiring removal through what is considered an "infected field" in CPT terminology. The American Urological Association guidelines emphasize that prosthetic surgery should not be performed in the presence of infection, and special considerations are required when dealing with a malfunctioning device 1.
When a penile prosthesis malfunctions, the surgical approach must account for potential infection and contamination. Code 54411 specifically addresses the increased complexity and risk associated with removing and replacing components through an infected field.
Clinical Considerations in Penile Prosthesis Surgery
The American Urological Association guidelines highlight several important considerations for penile prosthesis procedures:
- Preoperative preparation should ensure the patient is free of urinary tract infection and has no infections elsewhere 1
- Broad-spectrum antibiotics providing both Gram-negative and Gram-positive coverage should be administered preoperatively 1
- Inflatable penile prostheses are preferred over malleable devices due to improved mechanical reliability and closer to normal flaccidity and erection 1
Recent evidence suggests that antibiotic prophylaxis regimens may influence infection rates, with some combinations potentially providing better protection than others 1, 2.
By correctly coding this procedure as 54411, the complexity of removing a malfunctioning device and replacing it with a new prosthesis in the same surgical session is properly reflected.