UCR 072: Implantable Penile Prosthesis Questions; "Incident To" (PTNS example)

October 15, 2021

Mark, Ray, and Scott revisit a question from Episode 068 about an Implantable Penile Prosthesis. Also, they discuss several additional IPP questions.  Finally, they had a question about PTNS that sparked an "Incident To" clarification discussion.


Original IPP Question 

A) Please help me code this! Patient already had the procedure and there is a pending auth. that won't be approved until I send them the code(s). Thanks!!!
Revision of IPP including cystotomy removal & replacement of IPP Reservoir.

b) How do I code this scenario?
IPP Reservoir eroded into patient's bladder, Dr. Removes the foreign body in the bladder and replaces the 1 component of the IPP. Any help would be greatly appreciated!!! Thanks! Ethel

Answered: Episode 068 (9:20)


The procedure involved opening the bladder, removing the prosthetic reservoir, replacing with a new reservoir only in a new location and closing the bladder.
Appreciate your help here.

Additional IPP Questions

Good Morning, thank you so much for answering my previous question regarding the QW modifier. While I was listening to this episode, you answered another question on IPP's. We do a lot of these and I have a few follow up questions if I may. 
1. You mentioned that if you remove and replace only 1 component of an IPP, you should use 54408. I was reading an article from AMS (amsmenshealth.com) and it said they would recommend using 54410-52? I do like the idea of using the 54408 because it takes forever for a claim to be paid with modifier 52. 
2. What if you remove a multi-component and replace with a malleable? Would you use 54406 and 54400?
3. Last one - Same scenario - remove the IPP (in total) and replace with malleable but this patient has a hx of erosion on his left so the malleable was only placed on his right. 

Thanks in advance for your wisdom. Is is always greatly appreciated!

PTNS Question and "Incident To" Discussion

I wanted to see if anyone knew of a resource (authoritative such as CMS) that could give me guidelines on reporting PTNS in office setting. My Urologists are stating they can have the MA perform the service and do not need to co-sign the nurse note. I disagree. Does anyone have advice and resources I can take back to them or am I wrong? Thanks! 

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