Urology Coding Alert

Question: My urologists did an extensive four-hour debridement of Fournier's gangrene involving the penile skin, scrotum, and a portion of the perineum. They also did extensive debridement into the flank, the space of Retzius, the prevesical space, and the retroperitoneum including the area of the great vessels. And they performed a right radical orchiectomy and inserted a suprapubic tube. I am aware that there are new codes available for Fournier's debridement in 2005, but this happened on Dec. 29, 2004.

Maine Subscriber

Answer: Since the date of service was in 2004, you won't be able to use the new Fournier's debridement found in the 2005 CPT Manual. Instead, report the following CPT Codes:
  CPT 49060 (Drainage of retroperitoneal abscess; open) for the retroperitoneal exploration and drainage of the abscess formation that was most likely present
  CPT 51040 (Cystostomy, cystotomy with drainage) for the suprapubic cystostomy
  CPT 51080 (Drainage of perivesical or prevesical space abscess) for the drainage of the prevesical and perivesical spaces
  CPT 54530 (Orchiectomy, radical, for tumor; inguinal approach) for the radical orchiectomy
  CPT 55150 (Resection of scrotum) for the scrotal resection

CPT 11043 (Debridement; skin, subcutaneous tissue, and muscle) for the rest of the penile and perineal   debridement. Tip: The retroperitoneal dissection is the highest paying code, and this should be listed first.
 
You could also append modifier -22 (Unusual procedural services) to 49060 or 11043, but this would probably complicate the issue more for the carrier and hold up payments.