Wiki Mucosal collar flaps

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I'm new to a group of peds urologists who did not previously have a coder. I still have a poor understanding. My providers are trying to bill 14040 when mucosal collar flaps are mobilized along with angulation correction. Is the work described even separately billable? I'm having a hard time finding this info.

Below is the description of the procedure. Provider billed 54360, 54161, 14040.

After obtaining informed consent from his mother, satisfactory general anesthesia was obtained. Lower abdomen, groin, and genitalia were prepped and draped in the usual sterile fashion after a caudal block was administered. The phimosis was relieved, adhesions were lysed. A suture was passed through the glans and used for retraction. An incision was made 5 mm from the sulcus on mucosal collar swinging on either side laterally, leaving mucosal collar flaps and continued in an inverted V shape fashion ventrally to the level of the glans to resect his tight frenulum and the redundant mucosal collar tissue. The dissection proceeded down to the Buck's fascia and his penis was degloved to the base. All dysgenic bands contributing to the penile angulation were released. Nonetheless, artificial erection revealed persistent ventral angulation, which was repaired with dorsal plications of 6-0 PDS. Once his penis was straightened, an outer circumferential incision was made and the redundant foreskin was removed. The mucosal collar flaps were mobilized in midline and brought together with interrupted 5-0 chromics for repair. The circumcision line was closed with interrupted 5-0 chromics tacking it down to the Buck's fascia in multiple locations to repair his hidden penis as well. Hemostasis was assured, ointment was applied, and he was awakened in the Operating Room, having tolerated the procedure with no known complication.


They are actually billing 14040 with all repair surgeries and we are trying gather some info for them. We know size of defects is a requirement per CPT manual, just trying to figure out what work is billable. The main information that I have is when 14040 is billable in the context of hypospadias repair.

Any and all help is much appreciated. :)
 
I would suggest the following coding for your clinical scenario:
54360 for the correction of the penile angulation
54161 for the circumcision including the mucosal flaps; 14040 would be included.
 
This sounds like a chordee issue, but he is not calling it that. I say this because
1) because he degloves with dysgenic bands/fibrous tissue (making it bend/curve)
2) checks the angulation with a artificial erection, and sees that there is still angulation - so far code would be 54300
3) there is debate about wither the "plication" suture changes the code to 54360.
* because the suture is on penis proper tissue phalloplasty correcting angulation
vs
* Plication suture is just a technique to continue to fix the angulation - I believe the code should still be 54300 at this point.
4) he does the circ -an outer circumferential incision was made and the redundant foreskin was removed - 54161
5) mucosal collar flap - cpt provides a code for a chordee with flap - code should now become 54304!
6) tacking it down to the Buck's fascia in multiple locations to repair his hidden penis as well.
* our surgeon would say something like "tacking sutures at 6 and 12:00 for angulation, what they are doing is giving an angle appearance between the penis and scrotum.
* this is part of the 54304 to me.
Note: he calls this a Hidden penis in the op note details, in a hidden penis the SKIN comes up to far on the penis giving it a buried penis appearance.
This could be addressed several ways, non- of which is documented here. Here he documents releasing those dysgenic fibrous bands that are making the penis curve.
Typical chordee development has a short appearance on one side (meaning there is deficient skin due to dysplastic fibers pulling) and longer more skin on the opposite side, and a hooded penis due to the anomaly development.

When there is the deficient skin he uses the extra skin on the other side or uses the prepuce tissue to make flaps from the other side. In this case would be 54304. If it was a different issue, like a peno-scrotal issue hiding the penis then14040 would be a good choice for the flaps. But again, cpt provides us with a code for chordee not just repaired (54300) but corrected (54304) using flaps.

If possible for you read the CDR for these codes.
 
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