How To Use CPT Code 54110

CPT 54110 describes the excision of penile plaque, specifically for the treatment of Peyronie’s disease. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 54110?

CPT 54110 is used to describe the excision of penile plaque, which is performed to correct Peyronie’s disease. This condition is characterized by the presence of abnormal fibrous tissues in the penis, leading to severe penile curves, pain during erection, and the formation of lumps within the shaft of the penis.

2. Official Description

The official description of CPT code 54110 is: ‘Excision of penile plaque (Peyronie disease).’ This procedure involves the removal of plaque or abnormal fibrous tissues in the penis to address the symptoms and complications associated with Peyronie’s disease.

3. Procedure

1. When performing CPT 54110, the healthcare provider begins by appropriately prepping and anesthetizing the patient.
2. An incision is made around the penis, and the skin is retracted to expose the penile plaque.
3. The provider carefully excises the plaque, ensuring the preservation of important nerves and small blood vessels.
4. After the excision, the provider closes the skin using sutures.

4. Qualifying circumstances

CPT 54110 is used for patients diagnosed with Peyronie’s disease, a condition characterized by the presence of plaque or abnormal fibrous tissue in the penis. The procedure is performed to address severe penile curves, pain during erection, and the formation of lumps within the shaft of the penis. It is important to note that the cause of Peyronie’s disease is often uncertain.

5. When to use CPT code 54110

CPT code 54110 should be used when a healthcare provider performs the excision of penile plaque to treat Peyronie’s disease. It is important to ensure that the procedure is specifically aimed at addressing the symptoms and complications associated with this condition.

6. Documentation requirements

To support a claim for CPT 54110, the healthcare provider must document the following information:

• Patient’s diagnosis of Peyronie’s disease
• Details of the procedure, including the incision, excision of plaque, and closure of the skin
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 54110, ensure that the procedure is performed specifically for the treatment of Peyronie’s disease. It is important to follow the appropriate coding guidelines and accurately document the procedure to support the claim.

8. Historical information

CPT 54110 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2010, with the description being updated to ‘Excision of penile plaque (Peyronie disease).’ There have been no further updates to the code since then.

9. Examples

1. A healthcare provider performs the excision of penile plaque to correct severe penile curves and pain during erection in a patient diagnosed with Peyronie’s disease.
2. During the procedure, the provider removes the abnormal fibrous tissues in the penis, addressing the patient’s symptoms and improving their quality of life.
3. Another patient with Peyronie’s disease undergoes the excision of penile plaque to alleviate the discomfort caused by the formation of lumps within the shaft of the penis.
4. The healthcare provider carefully excises the plaque, ensuring the preservation of important nerves and blood vessels in the penis.
5. After the procedure, the patient experiences a reduction in penile curvature and pain during erection, leading to an improved sexual function.
6. A different patient with Peyronie’s disease undergoes the excision of penile plaque to address the shortening of the penis caused by the condition.
7. The healthcare provider performs the procedure, removing the plaque and restoring the patient’s penile length.
8. Following the excision of penile plaque, the patient experiences an improvement in their self-esteem and sexual satisfaction.
9. Another patient with Peyronie’s disease seeks treatment through the excision of penile plaque to address both the penile curvature and pain during erection.
10. The healthcare provider successfully removes the plaque, resulting in a straighter penis and reduced discomfort for the patient.