Wiki circumcision adult male with penoplasty

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ataughrin@yahoo.com

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Hello,
Need some help

My provider did a circumcision and extensive reconstruction of the penis . I tried to research and can not find a cpt for Penoplasty
I was finding articles to bill Circumcision with Modifier 22 but the reimbursement is still low even with that modifier and the provider stated he should be paid more as besides the extensive reconstruction the surgery also took over 2 hours. I have researched CMS,AUA,cpt book and I can not come up with an appropriate cpt code to use other then the Circumcision 54161 with Mod 22

Thanks
In the report after the circumcision it states
There was
severe obliteration of the sulcus at the ventral aspect of the glans requiring
extensive reconstruction with 4-0 chromic sutures
 
I too have a surgery similar to what you are asking about. I have searched high and low for a penoplasty. Even though this procedure refers to it also as a phalloplasty, what was done isn't exactly the same thing as a phalloplasty or am I not understanding.

Dorsal slit of approximately 2 cm was created, which allowed exposure of the remainder of the glans and manual disruption of the remaining adhesions to expose the corona circumferentially. The urethral meatus was noted to be patent. There were no masses or lesions on the glans. Once we had the penis well exposed, liposuction was performed to decrease the subpubic fat pad (liposuction was performed by another surgeon). With the fatty tissue decreased, we assessed the laxity of the tissue just above the penis, and planned skin excision to take in some of the laxity in this location. An elliptical skin incision above the base of the penis was created and excised with cautery (again, performed by another surgeon). Skin edges were reapproximated and then we did transpose the anchoring point for the dorsal aspect of the penis approximately 3 cm superior to help keep the glans elevated and away from the surrounding subcutaneous tissues. Deep anchoring suture of 0 PDS was placed at the skin edges of the suprapubic skin down to the pubic symphysis to help again prevent encroachment of this tissue onto the glans.

Phalloplasty was then performed by connecting the previous dorsal slit incision to the suprapubic skin to pull the penis superiorly in this location. Once we had the skin anchored with 3-0 chromic sutures from the penile skin to the subcutaneous pubic skin, closure was completed of the previous skin excision area using a running 3-0 Monocryl suture. At the conclusion, the glans penis was well exposed and there did not appear to be the ability for encroachment of the subpubic skin over the top of this area again. We dressed the glans with antibiotic ointment and sterile gauze dressing, ABD pads were placed over the liposuction locations, and then compressive shorts were placed to give additional compression over the area of liposuction with a small hole cut in the front to allow exposure of the penis for voiding.

Thank you in advance. Any help would be greatly appreciated
 
Hi
I'd use CPT 54322 for surgery above-phalloplasty (includes circumcision). I d use for a penoplasty CPT 54360 if trying to correct it in linear form.
I hope this data helps you somewhat.
Lady T
 
54322 is for correction of hypospadias, which is not the problem based on the note. 54360 would be indicated as the code description indicates angle, "Deep anchoring suture of 0 PDS was placed at the skin edges of the suprapubic skin down to the pubic symphysis to help again prevent encroachment of this tissue onto the glans."
If the patient was circumcised
54163 Repair incomplete circumcision
14040 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less
"connecting the previous dorsal slit incision to the suprapubic skin to pull the penis superiorly in this location."
You may also want to consider
53450 Urethromeatoplasty, with mucosal advancement.

I've been coding pediatric reconstructive surgeries for 8 years. There isn't a specific phalloplasty/glansplasty code. You really want to talk with your provider so get a better understanding
 
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