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

Coding Symposium
David H. Ewalt, MD, FAAP
Urology Clinics of North Texas
North Texas Pediatric Urology Associates
Dallas, Texas
AAP 10/8/06
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
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
• 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.
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
Case #1 % Response to each CPT
55175
59
54324
52
14040
32
54326
30
54328
25
54235
19
54300
16
15740
12
54360
12
55180
11
54161
10
0
10
20
30
40
50
60
70
Number of CPT codes assigned – Case # 1
2006 Pediatric Urology Coding Survey
35
30
# of Responses
25
20
15
10
5
0
1
2
3
4
5
Number of CPT Codes Assigned - Case #1
6
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
• 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.
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 ??
Case #2 - % Response per CPT
14040
35
55175
35
54300
33
54161
31
54360
29
54304
15
54180
6
55899
3
0
5
10
15
20
25
30
35
40
Number of CPT codes assigned – Case # 2
2006 Pediatric Urology Coding Survey
50
45
40
# of Responses
35
30
25
20
15
10
5
0
1
2
3
4
# of CPT Codes Assigned - Case #2
5
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
• 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.
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
Responses Case #3
60
54300
54161
29
26
14040
54360
25
54304
25
54235
11
Other
7
0
10
20
30
40
50
60
70
Number of CPT codes assigned – Case # 3
2006 Pediatric Urology Coding Survey
60
# of Responses
50
40
30
20
10
0
1
2
3
4
# of CPT Codes Assigned - Case #3
5
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