CPT code 54410 is reported for replacement but the code descriptor states “Removal and replacement of all component (s) of a multi component, inflatable penile prosthesis at the same operative session.”
64.0 is a specific code and is valid to identify a procedure. 2012 ICD-9-CM Procedure Code 64.1 Diagnostic Procedures On The Penis A child code below 64.1 with greater detail should be used.
2014 ICD-9-CM Diagnosis Code 996.77 : Other complications due to internal joint prosthesis Free, official information about 2014 (and also 2015) ICD-9-CM diagnosis code 996.77, including coding notes, detailed descriptions, index cross-references and ICD-10-CM conversion.
Therefore, we are not sure if this code would include the prosthesis component replaced. CPT code 54410 is reported for replacement but the code descriptor states “Removal and replacement of all component (s) of a multi component, inflatable penile prosthesis at the same operative session.”
64.2 is a specific code and is valid to identify a procedure.
64.0 is a specific code and is valid to identify a procedure.
The implantation of a penile prosthesis is considered medically necessary for individuals who: 1 Have erectile dysfunction of greater than 6 months duration; and 2 Experienced failure of or have contraindication to less invasive treatments including, but not limited to oral medications, intracavernosal injection, intra-urethral medications and vacuum constriction devices.
Other complications were implant migration and tissue erosion. In a review by Phe (2012), the rate of infection decreased to 1% with the utilization of antibiotic impregnated implants. In a report on 98 men in a national database who had penile prosthesis implantation between 2005 and 2013 (Palma-Zamora, 2017), the overall 30-day complication rate was 11% (n=11). The complications included surgical site infection (n=6), transfusion (n=3), urinary tract infection (n=1) and sepsis/shock (n=1).
The guideline stated, “the potential risks and burdens of prosthesis surgery include the risks inherent in the surgical procedure, possible changes in the appearance of the penis, and the potential for device malfunction or failure”. Penile prostheses have primarily been evaluated in uncontrolled case series.
A 2020 systematic review by Dick and colleagues identified 14 studies reporting on outcomes after penile prosthesis implantation in individuals with solid organ transplant. Most of the studies were case reports or case series but there were also 2 retrospective cohort studies.
Fifteen studies focused on diabetes mellitus which was found in pooled analyses to be significantly associated with risk of infection (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.38 to 4.47). Other factors significantly increasing risk of infection in individuals with penile prostheses were immunosuppression (3 studies, OR, 20.99; 95% CI, 0.71 to 622.34) and obesity (2 studies, OR, 18.24; 95% CI, 1.43 to 231.98). However, other than in the analysis on diabetes mellitus, numbers of studies and total sample sizes were small and thus estimates of increased risk were imprecise as indicated by wide confidence intervals.
The implantation of a penile prosthesis is considered medically necessary for individuals who have not responded to intracavernosal injection, intra-urethral medications, a vacuum constriction device and oral medications, or such treatment is not acceptable to the individual or his partner and who meet one of the following criteria:
For men with testosterone deficiency, PDE5 inhibitors can be supplemented with testosterone therapy (AUA, 2018). If oral medications are not sufficient, a vacuum device, which is a noninvasive modality, is often recommended before a penile prosthesis.