UCR 242: Pediatric penile torsion repair, MA scope of practice, and incident to billing for a hospital-employed urologist

May 9, 2025 

In this episode, Scott, Mark, and Ray answer questions that came into the PRS Helpdesk.

1. One of my specialties is pedsurology and there is just not much guidance for surgery coding.
   Is it appropriate to use 54360 (plastic operation on penis to correct angulation) for correction of penile torsion?
   I found an article from AAPC dated 2005 that stated to use 14040 for penile torsion repair when performed with a MAGPI hypospadias repair (54322).
   What if the penile torsion repair is not performed with another procedure or at least without a hypospadias repair?
2. If Medical technologists (Medical assistants trained to perform Urodynamics) can perform this test why are Medical assistants not permitted by CMS to perform catheter insertion and removal in non regulated sites of services? (I have seen MAs in non regulated spaces perform catheter changes, bladder instillations--etc---how are practices able to get away with having MAs incorporated in their work flow as such?)
3. In regulated sites of service (Hospital based clinics) what documentation should be used to ensure proper billing when an MA performs 51798 (bladder scan) (incident to billing for a hospital-employed physician).