How To Use CPT Code 54400

CPT 54400 describes the insertion of a non-inflatable (semi-rigid) penile prosthesis to treat erectile dysfunction. 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 54400?

CPT 54400 involves the insertion of a semi-rigid non-inflatable synthetic material into the penis to treat erectile dysfunction. This procedure is performed by a healthcare provider and requires a transverse incision on the pubic area above the penis. The provider partially removes the spongy tissues of the penis, known as the corpora cavernosa, and inserts the prosthesis into the erectile compartments. The implant consists of two semi-rigid rods, such as silicone rods, which are inserted into the penis. The tissues and incisions are then closed by suturing.

2. Official Description

The official description of CPT code 54400 is: ‘Insertion of penile prosthesis; non-inflatable (semi-rigid).’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. A transverse incision is made on the pubic area above the penis.
3. The provider partially removes the corpora cavernosa, or spongy tissues of the penis.
4. The prosthesis, consisting of two semi-rigid rods, is inserted into the erectile compartments in the penis.
5. The provider closes the tissues and incisions by suturing.

4. Qualifying circumstances

CPT 54400 is used to treat erectile dysfunction in patients who require the insertion of a non-inflatable, semi-rigid penile prosthesis. This procedure is performed by a healthcare provider and may be necessary for patients who have not responded to other treatments for erectile dysfunction.

5. When to use CPT code 54400

CPT code 54400 should be used when a healthcare provider performs the insertion of a non-inflatable, semi-rigid penile prosthesis to treat erectile dysfunction. It is important to note that this code is specific to the insertion of a non-inflatable prosthesis and should not be used for other types of penile prosthesis procedures.

6. Documentation requirements

To support a claim for CPT 54400, the healthcare provider must document the following information:

• Patient’s diagnosis of erectile dysfunction
• Description of the procedure performed, including the type of prosthesis inserted
• Date of the procedure
• Details of any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 54400, ensure that the procedure performed matches the description of the code. It is important to accurately document the details of the procedure and any additional services provided. CPT code 54400 should not be reported with other codes unless additional procedures were performed, such as urethral repair. In such cases, appropriate modifiers should be appended to indicate the reduced services or multiple procedures.

8. Historical information

CPT code 54400 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider performs the insertion of a non-inflatable penile prosthesis for a patient with erectile dysfunction.
2. A patient undergoes the procedure to have a semi-rigid penile prosthesis inserted to treat his erectile dysfunction.
3. A healthcare provider performs the insertion of a non-inflatable penile prosthesis for a patient who has not responded to other treatments for erectile dysfunction.
4. A patient with erectile dysfunction undergoes the procedure to have a semi-rigid penile prosthesis inserted by a healthcare provider.
5. A healthcare provider performs the insertion of a non-inflatable penile prosthesis for a patient who desires a more permanent solution for his erectile dysfunction.
6. A patient undergoes the procedure to have a semi-rigid penile prosthesis inserted to improve his erectile function.
7. A healthcare provider performs the insertion of a non-inflatable penile prosthesis for a patient who has tried other treatments without success.
8. A patient with erectile dysfunction undergoes the procedure to have a semi-rigid penile prosthesis inserted as a treatment option.
9. A healthcare provider performs the insertion of a non-inflatable penile prosthesis for a patient who wishes to regain his sexual function.
10. A patient undergoes the procedure to have a semi-rigid penile prosthesis inserted to address his erectile dysfunction.