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The procedure described by CPT® Code 54111 involves the excision of penile plaque associated with Peyronie's disease, which is a condition characterized by the formation of a hard, fibrous layer of scar tissue, known as plaque, beneath the skin of the penis. This plaque typically develops in the spongy erectile tissue, leading to a curvature of the penis during erection. The excision process begins with an incision in the overlying tissue to expose the plaque. Once exposed, the plaque may be either expanded through several linear incisions or completely excised. Following the excision or expansion, the affected area is covered using a graft, which can be made from skin, vein, or synthetic material. This specific code, 54111, is utilized when a graft measuring 5 cm or less is employed. It is important to note that there are alternative codes for similar procedures: CPT® Code 54110 is used when the procedure is performed without a graft, and CPT® Code 54112 is applicable when a graft exceeding 5 cm is required. This structured approach ensures that the procedure is accurately documented and coded for proper reimbursement and compliance.
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The excision of penile plaque associated with Peyronie's disease is indicated for patients who exhibit the following conditions:
The procedure for excising penile plaque with grafting involves several key steps:
Post-procedure care for patients undergoing excision of penile plaque with grafting includes monitoring for any signs of infection, managing pain with prescribed medications, and following up with the healthcare provider to assess healing. Patients are typically advised to avoid sexual activity for a specified period to allow for proper healing of the surgical site. Follow-up appointments are essential to evaluate the success of the graft and the overall outcome of the procedure.
| Short Descr | TREAT PENIS LESION GRAFT | Medium Descr | EXC PENILE PLAQUE GRAFT &/5 CM LENGTH | Long Descr | Excision of penile plaque (Peyronie disease); with graft to 5 cm in length | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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 |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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