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I am really new to Pediatric Urology and have a question.

I know that 14040 may be billed when skip flaps are used to cover defects.
1. Coming from some background general surgery and oculoplastics, I'm stuck on the idea that flap/defect sizes have to be documented, but feel like there should be exclusions when used in this manner.
2. Would this also be the correct code for a mucosal collar?

I have been researching in down time for weeks and can't find a good resource for this specific question. Any help or links to resources are really appreciated. Our mgmt is working on some resources for us, but I don't have much right now. :(

Here is an example of a procedure that's confusing to me:

Provider wants to bill 54360, 54161, 14040

The patient was brought to the operating room. He was prepped and draped in the standard sterile fashion in supine position. A penile retraction stitch was placed in the glans using 5-0 Prolene suture. The frenulum was then isolated and cauterized using bipolar electrocautery. Circumferential markings were made on the penile shaft just proximal to the glans, as well as on the exterior portion of the foreskin. Two circumferential incisions were made on the penile shaft. A sleeve of foreskin was isolated and brought dorsally, and subsequently removed using bipolar electrocautery. All bleeding points were cauterized using bipolar electrocautery. There was no active bleeding. The edge of the penile skin was then sewn to the edge of the mucosal collar using a series of interrupted stitches, placed with 5-0 Monocryl suture. The penis was then cleaned and dried. Dermabond was placed over the incision, followed by Vaseline ointment. The patient tolerated the operation well. He was extubated, and transferred to the post-anesthesia care unit in stable condition. He will be discharged home with follow-up on an as-needed basis.The patient was brought to the operating room. He was prepped and draped in the standard sterile fashion in supine position. A penile retraction stitch was placed in the glans using 5-0 Prolene suture. The frenulum was then isolated and cauterized using bipolar electrocautery. Circumferential markings were made on the penile shaft just proximal to the glans, as well as on the exterior portion of the foreskin. Two circumferential incisions were made on the penile shaft. A sleeve of foreskin was isolated and brought dorsally, and subsequently removed using bipolar electrocautery. All bleeding points were cauterized using bipolar electrocautery. There was no active bleeding. The edge of the penile skin was then sewn to the edge of the mucosal collar using a series of interrupted stitches, placed with 5-0 Monocryl suture. The penis was then cleaned and dried. Dermabond was placed over the incision, followed by Vaseline ointment. The patient tolerated the operation well. He was extubated, and transferred to the post-anesthesia care unit in stable condition. He will be discharged home with follow-up on an as-needed basis.
 
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