Coding Symposium

1
Coding Symposium

• David H. Ewalt, MD, FAAP
• Urology Clinics of North Texas
• North Texas Pediatric Urology Associates
• Dallas, Texas
• AAP 10/8/06

2
Coding Pearls

• Document explicitly in the operative note the
  exact procedure performed
• Use the most accurate ICD-9 codes for the
  diagnosis and most applicable CPT code(s) for the
  procedure performed
• Coding is NOT an exact science

3
Correction of Chordee 3 codes

• 54300 - Plastic operation of penis for
  straightening of chordee (eg, hypospadias), with
  or without mobilization of urethra. RVU 10.39
• 54304 - Plastic operation on penis for correction
  of chordee or for first stage hypospadias repair
  with or without transplantation of prepuce and/or
  skin flaps 12.47
• 54360 - Plastic operation on penis to correct
  angulation. 11.91

4

• Case 1
• History
• 6 month old male with distal (1 cm) hypospadias
  with moderate chordee and tethering of the
  scrotum to the ventral penis.
• Procedure performed
• Tubulerized incised plate urethroplasty procedure
  performed with deepithelialized vascular pedicle
  from right Byars flap to cover the repair along
  with removal of excess prepuce. Plication of the
  dorsal corpora performed to correct chordee.
  Simple scrotoplasty to correct penoscrotal
  fusion.

5
CPT Code Usage Case 1

• 54324 - One stage distal hypospadias repair (with
  or without chordee or circumcision) with
  urethroplasty by local skin flaps (eg, flip-flap,
  prepucial flap). 16.29
• 54326 - One stage distal hypospadias repair (with
  or without chordee or circumcision) with
  urethroplasty by local skin flaps and
  mobilization of urethra. 15.70
• 54328 - One stage distal hypospadias repair (with
  or without chordee or circumcision) with
  extensive dissection to correct chordee and
  urethroplasty with local skin flaps, skin graft
  patch, and/or island flap. 15.63
• 15740 - Flap island pedicle. 10.23
• 14040 - Adjacent tissue transfer or
  rearrangement, genitalia defect 10 sq cm or
  less. 7.86
• 55175 - Scrotoplasty simple. 5.23
• 55180 - Scrotoplasty complicated. 10.70
• 54300 - Plastic operation of penis for
  straightening of chordee (eg, hypospadias), with
  or without mobilization of urethra. 10.39
• 54360 - Plastic operation on penis to correct
  angulation. 11.91
• 54161 - Circumcision, surgical excision other
  than clamp, device or dorsal slit except
  newborn. 3.27
• 54235 - Injection of corpora cavernosa with
  pharmacologic agent(s) (eg, papaverine,
  phentolamine). 1.19

6
Case 1 Response to each CPT
7
Number of CPT codes assigned Case 1
8
Case 1 Consensus codes

• 54324 One stage distal hypospadias repair (with
  or without chordee or circumcision) with
  urethroplasty by local skin flaps (eg, flip-flap,
  prepucial flap). 16.29
• 15740 Flap island pedicle. 10.23
• 55175 Scrotoplasty simple. 5.23

9
(No Transcript)
10

• Case 2
• History
• 6 month old male with buried or concealed penis.
• Procedure performed
• Phalloplasty with rotation of dorsal preputial
  flaps to cover the ventral penis along with
  removal of excess prepuce.

11
CPT Code Usage Case 2

• 54300 - Plastic operation of penis for
  straightening of chordee (eg, hypospadias), with
  or without mobilization of urethra. 10.39
• 54304 - Plastic operation on penis for correction
  of chordee or for first stage hypospadias repair
  with or without transplantation of prepuce and/or
  skin flaps 12.47
• 54360 - Plastic operation on penis to correct
  angulation. 11.91
• 14040 - Adjacent tissue transfer or
  rearrangement, genitalia defect 10 sq cm or
  less. 7.86
• 54161 - Circumcision, surgical excision other
  than clamp, device or dorsal slit except
  newborn. 3.27
• 55175 - Scrotoplasty simple. 5.23
• 54180 - Scrotoplasty complicated. 10.70
• 55899 - Unlisted procedure, male genital system
  ??

12
Case 2 - Response per CPT
13
Number of CPT codes assigned Case 2
14
Case 2 Consensus codes

• 54300 Plastic operation on penis to correct
  angulation. 10.39
• 14040 Adjacent tissue transfer or rearrangement,
  genitalia defect 10 sq cm or less. 7.86

15

• Case 3
• History
• 6 month old male with chordee without
  hypospadias.
• Procedure performed
• Phalloplasty with rotation of dorsal preputial
  flaps to cover the ventral penis along with
  removal of excess prepuce. Corporal placation
  performed to correct chordee.

16
CPT Code Usage Case 3

• 54300 Plastic operation of penis for
  straightening of chordee (eg, hypospadias), with
  or without mobilization of urethra. 10.39
• 54304 Plastic operation on penis for correction
  of chordee or for first stage hypospadias repair
  with or without transplantation of prepuce and/or
  skin flaps. 12.47
• 54360 Plastic operation on penis to correct
  angulation. 11.91
• 14040 Adjacent tissue transfer or
  rearrangement, genitalia defect 10 sq cm or
  less. 7.86
• 54161 Circumcision, surgical excision other
  than clamp, device or dorsal slit except
  newborn. 3.27
• 54235 Injection of corpora cavernosa with
  pharmacologic agent(s) (eg, papaverine,
  phentolamine). 1.19

17
Responses Case 3
18
Number of CPT codes assigned Case 3
19
Case 3 Consensus codes

• 54304 Plastic operation of penis for
  straightening of chordee (eg, hypospadias), with
  or without mobilization of urethra. 12.47
• 14040 Adjacent tissue transfer or rearrangement,
  genitalia defect 10 sq cm or less. 7.86