Wiki Urethrocutaneous Fistula Due to Piercing?

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tori.a

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I would code this as 54326 rather than 53520, but I'm wondering your thoughts since the diagnosis is a fistula due to a piercing rather than hypospadias. I still feel the 54326 most accurately represents what was done. Thanks!

Indication: history of distal urethral cutaneous fistula secondary to a previous piercing. He initial fistula closure earlier this year but has a recurrence.
Preoperative diagnosis: Urethrocutaneous fistula
Postop diagnosis: Same
Findings: Fossa navicularis urethrocutaneous fistula. Penile skin flap used for the urethroplasty
Operation performed: Urethroplasty using penile skin flap

Description of operation:
The patient's meatus was calibrated to 30 French using sounds. A circumcision incision was then
made and incision was extended in the midline ventrally towards the fistula site. The fistula
opening was exposed. The fistula was at the fossa navicularis site. The fistula was then entirely
opened from the fossa navicularis to the urethral meatus. An approximately 1 x 1 centimeter
penile skin flap was then taken from the distal aspect of the penis on the left side and brought to
the fossa navicularis. The penile skin flap was then sutured in place to the urethral mucosa using
4-0 Vicryl in interrupted and running fashion. Glans flaps were also performed. Subcutaneous
tissue was then taken from the right side of the penile skin and placed over the repair site. The
glans was then sutured in place using 2-0 Vicryl in a interrupted fashion. The skin was
reapproximated using 3-0 chromic in a interrupted and running fashion. Sterile dressing was then
applied. The LMA was then removed. And patient was taken to recovery room stable condition.
 
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tori.a said:
I would code this as 54326 rather than 53520, but I'm wondering your thoughts since the diagnosis is a fistula due to a piercing rather than hypospadias. I still feel the 54326 most accurately represents what was done. Thanks!

Indication: history of distal urethral cutaneous fistula secondary to a previous piercing. He initial fistula closure earlier this year but has a recurrence.
Preoperative diagnosis: Urethrocutaneous fistula
Postop diagnosis: Same
Findings: Fossa navicularis urethrocutaneous fistula. Penile skin flap used for the urethroplasty
Operation performed: Urethroplasty using penile skin flap

Description of operation:
The patient's meatus was calibrated to 30 French using sounds. A circumcision incision was then
made and incision was extended in the midline ventrally towards the fistula site. The fistula
opening was exposed. The fistula was at the fossa navicularis site. The fistula was then entirely
opened from the fossa navicularis to the urethral meatus. An approximately 1 x 1 centimeter
penile skin flap was then taken from the distal aspect of the penis on the left side and brought to
the fossa navicularis. The penile skin flap was then sutured in place to the urethral mucosa using
4-0 Vicryl in interrupted and running fashion. Glans flaps were also performed. Subcutaneous
tissue was then taken from the right side of the penile skin and placed over the repair site. The
glans was then sutured in place using 2-0 Vicryl in a interrupted fashion. The skin was
reapproximated using 3-0 chromic in a interrupted and running fashion. Sterile dressing was then
applied. The LMA was then removed. And patient was taken to recovery room stable condition.
Click to expand...
Did you ever get an answer on this? I have a similar procedure and I am not positive on the coding. I was thinking the 54326 would be the better code.
 
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SonyaLynn51 said:
Did you ever get an answer on this? I have a similar procedure and I am not positive on the coding. I was thinking the 54326 would be the better code.
Click to expand...
No answer, but I ended up using 54326 for this procedure. I felt like 54326 was more appropriate for this one since there was a urethroplasty involved. I used 53520 for the initial fistula closure, note below:

Findings: Approximately 1 centimeter fistula that was closed in 2 layers
Drains: 20 French Foley catheter
Description of operation:
The patient's urethra and meatus was calibrated to 30 French using male sounds. The 30 French
male sound was left in place. A longitudinal incision was then made from the fistula site, which
was in frenulum dissection was then carried around the fistula. Bilateral glanular flaps were
created. The inner fistula opening was then closed using 4-0 Vicryl in a running fashion. The
skin was then closed using 3-0 Vicryl and 3-0 chromic in a running and interrupted fashion.
Sound was then removed and a 20 French Foley catheter was placed. Dermabond was also
placed over the incision. Patient was then taken to recovery in stable condition.
 
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