How To Use CPT Code 53447

CPT 53447 describes the removal and replacement of an inflatable urethral/bladder neck sphincter, including the pump, reservoir, and cuff, during the same operative session. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 53447?

CPT 53447 can be used to describe the surgical procedure in which a previously implanted artificial urinary sphincter is removed and replaced with a new one during the same operative session. This procedure is performed when a patient experiences complications after the initial implantation of the artificial urinary sphincter.

2. Official Description

The official description of CPT code 53447 is: ‘Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session.’

3. Procedure

1. The provider begins by making an incision in the suprapubic region and entering the pelvic space from the abdomen.
2. A urinary catheter is inserted, and the provider carefully removes all components of the previously implanted artificial sphincter, including the cuff, reservoir, and pump.
3. A new cuff or artificial sphincter system is selected and placed around the urethra during the same operative session, ensuring that the urethra closes tightly when the cuff inflates.
4. A space is created in the pubic region to hold the balloon, and a pump is placed in a pouch below the abdomen.
5. The provider instructs the patient on the use of the device, which involves inflating the cuff to close the urethra during periods of rest and temporarily deflating the cuff to allow urination.
6. Any bleeding is controlled, and the incision is closed in layers.

4. Qualifying circumstances

CPT 53447 is performed when a patient experiences complications after the initial implantation of an artificial urinary sphincter. This procedure is typically reserved for patients who suffer from urinary incontinence and have failed other conservative treatment options. The patient must be appropriately prepped and anesthetized, and the provider must ensure that there is no erosion of the sphincter cuff before proceeding with the removal and replacement.

5. When to use CPT code 53447

CPT code 53447 should be used when a provider performs the removal and replacement of an inflatable urethral/bladder neck sphincter, including the pump, reservoir, and cuff, during the same operative session. This code should not be used if the provider only removes or replaces one component of the artificial urinary sphincter. In cases of infection, CPT code 53448 should be used instead.

6. Documentation requirements

To support a claim for CPT code 53447, the provider must document the following information:

• Reason for the removal and replacement of the artificial urinary sphincter
• Details of the procedure, including the specific components removed and replaced
• Date and duration of the operative session
• Any additional procedures performed, such as cystoscopy
• Instructions provided to the patient regarding the use of the device
• Any complications or adverse events encountered during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 53447, ensure that the procedure involves the removal and replacement of the inflatable urethral/bladder neck sphincter, including the pump, reservoir, and cuff, during the same operative session. If the provider only removes or replaces one component of the artificial urinary sphincter, modifier 52 should be appended to the code. If the removal and replacement are performed due to infection, CPT code 53448 should be used instead. It is important to note that additional procedures, such as cystoscopy, may be performed before the removal and replacement, and separate codes should be reported for those procedures.

8. Historical information

CPT code 53447 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2002, with the description being updated to include the removal, repair, or replacement of the inflatable sphincter, including the pump and/or reservoir and/or cuff.

9. Examples

1. A patient experiences complications after the initial implantation of an artificial urinary sphincter, and the provider performs the removal and replacement of the inflatable urethral/bladder neck sphincter, including the pump, reservoir, and cuff, during the same operative session.
2. After a thorough evaluation, it is determined that a patient’s previously implanted artificial urinary sphincter is not functioning properly, and the provider performs the removal and replacement of the device during the same operative session.
3. A patient with urinary incontinence undergoes the removal and replacement of the inflatable urethral/bladder neck sphincter, including the pump, reservoir, and cuff, due to complications encountered after the initial implantation.
4. Following the identification of erosion of the sphincter cuff, the provider performs the removal and replacement of the artificial urinary sphincter, ensuring the patient’s continence is restored.
5. During a routine follow-up visit, it is discovered that a patient’s previously implanted artificial urinary sphincter is malfunctioning, and the provider decides to perform the removal and replacement of the device during the same operative session.