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

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
One stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps (eg, flip-flap, prepucial flap)
One stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps and mobilization of urethra
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
Flap; island pedicle
Adjacent tissue transfer or rearrangement, genitalia; defect 10 sq cm or less
Scrotoplasty; simple
Scrotoplasty; complicated
Plastic operation of penis for straightening of chordee (eg, hypospadias), with or without mobilization of urethra
Plastic operation on penis to correct angulation
Circumcision, surgical excision other than clamp, device or dorsal slit; except newborn
Injection of corpora cavernosa with pharmacologic agent(s) (eg, papaverine, phentolamine)

6. Case #1 % Response to each CPT

7. Number of CPT codes assigned – Case # 1

8. Case # 1 Consensus codes
One stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps (eg, flip-flap, prepucial flap)
15740 Flap; island pedicle
55175 Scrotoplasty; simple

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
Plastic operation of penis for straightening of chordee (eg, hypospadias), with or without mobilization of urethra
Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps
Plastic operation on penis to correct angulation
Adjacent tissue transfer or rearrangement, genitalia; defect 10 sq cm or less
Circumcision, surgical excision other than clamp, device or dorsal slit; except newborn
Scrotoplasty; simple
Scrotoplasty; complicated
Unlisted procedure, male genital system ??

12. Case #2 - % Response per CPT

13. Number of CPT codes assigned – Case # 2

14. Case # 2 Consensus codes
Plastic operation on penis to correct angulation
Adjacent tissue transfer or rearrangement, genitalia; defect 10 sq cm or less

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
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
54360 – Plastic operation on penis to correct angulation
14040 – Adjacent tissue transfer or rearrangement, genitalia; defect 10 sq cm or less
54161 – Circumcision, surgical excision other than clamp, device or dorsal slit; except newborn
54235 – Injection of corpora cavernosa with pharmacologic agent(s) (eg, papaverine, phentolamine)

17. Responses Case #3

18. Number of CPT codes assigned – Case # 3

19. Case # 3 Consensus codes
Plastic operation of penis for straightening of chordee (eg, hypospadias), with or without mobilization of urethra
Adjacent tissue transfer or rearrangement, genitalia; defect 10 sq cm or less