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The procedure described by CPT® Code 54435 involves the creation of a fistula in the corpora cavernosa of the glans penis, specifically aimed at relieving a condition known as priapism. Priapism is a prolonged and often painful erection that is not associated with sexual desire or stimulation. The fistulization process can also be referred to as an Ebbehoj or Winter procedure, both of which are minimally invasive surgical techniques. These procedures are typically performed under local anesthesia, allowing for pain control while minimizing the need for more extensive surgical intervention. During the procedure, the patient is positioned supine, and the penis is meticulously prepared and draped to maintain a sterile environment. A large bore biopsy needle or a scalpel tip is then carefully inserted through the glans penis into the corpora cavernosa, where a core of tissue is excised. This excision facilitates the drainage of accumulated blood, which is essential for alleviating the symptoms of priapism. To enhance the drainage process, gentle pressure may be applied from the base of the penis toward the glans, effectively milking the blood out of the corporal tissue. Following the procedure, the fistula is allowed to close spontaneously, which is a critical aspect of the healing process.
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The procedure associated with CPT® Code 54435 is indicated for the treatment of priapism, a condition characterized by a prolonged and often painful erection that occurs without sexual arousal. This condition can lead to significant discomfort and potential complications if not addressed promptly. The fistulization procedure aims to relieve the symptoms associated with priapism by facilitating the drainage of trapped blood within the corpora cavernosa.
The procedure for CPT® Code 54435 involves several critical steps to ensure effective fistulization of the corpora cavernosa. First, the patient is positioned supine on the surgical table, allowing for optimal access to the genital area. The penis is then thoroughly prepared and draped in a sterile manner to minimize the risk of infection. Following this preparation, a large bore biopsy needle or a scalpel tip is carefully inserted through the glans penis into the corpora cavernosa. This insertion is performed with precision to avoid damage to surrounding tissues. Once the needle or scalpel is in place, a core of tissue is excised from the corpora cavernosa. This excision is crucial as it creates an opening that allows the accumulated blood to drain from the corpora cavernosa, thereby alleviating the pressure and discomfort associated with priapism. To further assist in the drainage process, gentle pressure may be applied from the base of the penis toward the glans, effectively milking the trapped blood out of the corporal tissue. After the drainage is achieved, the fistula is allowed to close spontaneously, which is an important part of the healing process.
After the completion of the fistulization procedure, patients are typically monitored for any immediate complications or adverse effects. It is essential to assess the effectiveness of the procedure in relieving the symptoms of priapism. Patients may be advised to rest and avoid any strenuous activities for a specified period to promote healing. Follow-up appointments may be scheduled to evaluate the recovery process and ensure that the fistula is healing appropriately. Additionally, patients should be informed about potential signs of infection or other complications that may require further medical attention.
| Short Descr | REVISION OF PENIS | Medium Descr | CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM | Long Descr | Corpora cavernosa-glans penis fistulization (eg, biopsy needle, Winter procedure, rongeur, or punch) for priapism | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 118 - Other OR therapeutic procedures, male genital |
| 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) |
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| 2011-01-01 | Changed | Medium description changed. |
| Pre-1990 | Added | Code added. |
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