# Distal hypospadias repair, chordee repair & adj tissue transfer



## mkmgt001

Could someone please give me their opinion?  CCI allows CPT 54360 (Plastic operation on penis to correct angulation) & 14040 (Adjacent tissue transfer) to be reported with CPT 54324 (1-stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps (eg. flip-flap, prepucial flap)).  Modifier -59 isn't even required.  Based on the description of CPT 54324, I would have guessed that both CPT 54360 (chordee repair) & 14040 (adj tiss trans) would be unbundled. Should I allow these 3 codes to be reported together?  If I use CCI as my coding resource, I guess I should, but this seems wrong.....

Thanks much!
Mary


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## kalford

mkmgt001 said:


> Could someone please give me their opinion?  CCI allows CPT 54360 (Plastic operation on penis to correct angulation & 14040 (Adjacent tissue transfer) to be reported with CPT 54324 (1-stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps (eg. flip-flap, prepucial flap)).  Modifier -59 isn't even required.  Based on the description of CPT 54324, I would have guessed that both CPT 54360 (chordee repair) & 14040 (adj tiss trans) would be unbundled. Should I allow these 3 codes to be reported together?  If I use CCI as my coding resource, I guess I should, but this seems wrong.....
> 
> Thanks much!
> Mary


Hey Mary,


I realized  this years later but did you get an answer for this?  I am having issues where some carriers are not paying them together although the codes dont bundle. Just seeing if you gotten any feedback


Thanks


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## mkmgt001

Hi Kalford,

No, I never got a response to my question.   Sorry I can't help you further. 

Mary


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## chamby4054@gmail.com

*Hypospadias repair*

Per the American Urological Association, all hypospadias repairs include any and all chordee or angulation corrections.  54300 should not be reported separately.  14040 can be used if the surgeon creates a Byar's flap or a de-epithelialized scrotal flap as that is not included in the cpt descriptions. I will also note that 54300, 54360, or 54304 should not be added for a dorsal plication stitch or a Nesbitt wedge.  These are surgical techniques that are considered inclusive of a penile plastic repair procedure.  Hopefully you've both found the answer to this question but I spent hours upon hours researching this to find the right answer (and would have given my left toe to have found a response in a thread like this) so hopefully anyone else that comes along will benefit from the information. 

-Liz C.
 Urology Coder


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## hagand

chamby4054@gmail.com said:


> *Hypospadias repair*
> 
> Per the American Urological Association, all hypospadias repairs include any and all chordee or angulation corrections.  54300 should not be reported separately.  14040 can be used if the surgeon creates a Byar's flap or a de-epithelialized scrotal flap as that is not included in the cpt descriptions. I will also note that 54300, 54360, or 54304 should not be added for a dorsal plication stitch or a Nesbitt wedge.  These are surgical techniques that are considered inclusive of a penile plastic repair procedure.  Hopefully you've both found the answer to this question but I spent hours upon hours researching this to find the right answer (and would have given my left toe to have found a response in a thread like this) so hopefully anyone else that comes along will benefit from the information.
> 
> -Liz C.
> Urology Coder


Liz, I am finding this information quite useful right now.  This is the first time I have come across having to code this type of procedure.  And I am grateful for your information.  I don't know how many times I have found my question posted in certain circumstances, only to find that there is no answer......today is a good day!


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## arawl1981@yahoo.com

chamby4054@gmail.com said:


> *Hypospadias repair*
> 
> Per the American Urological Association, all hypospadias repairs include any and all chordee or angulation corrections.  54300 should not be reported separately.  14040 can be used if the surgeon creates a Byar's flap or a de-epithelialized scrotal flap as that is not included in the cpt descriptions. I will also note that 54300, 54360, or 54304 should not be added for a dorsal plication stitch or a Nesbitt wedge.  These are surgical techniques that are considered inclusive of a penile plastic repair procedure.  Hopefully you've both found the answer to this question but I spent hours upon hours researching this to find the right answer (and would have given my left toe to have found a response in a thread like this) so hopefully anyone else that comes along will benefit from the information.
> 
> -Liz C.
> Urology Coder


I'm new to peds urology and this was so incredibly helpful!!


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## DA4713

I am brand new to AAPC 
This discussion is just what I need. Spot on, thank you.


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## liqgold2@aol.com

When coding for a hypospadias repair, consider the location of the hypospadic opening and whether a single or multiple stage procedure will be performed. In your case of a distal hypospadias and the repair was done using a single stage. Therefore, bill 54322 or 54324 as the operation is dictated. Add extra coding as the case may be. Read what each procedure contains and bill accordingly basing coding on either of those codes mentioned..


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## Denises

Hi Dr. Ferragamo, Can you help educate me as to what is involved in CPT 54326 in respect to "mobilization of urethra" and how would the keywords be documented to pick up on 54326 vs 54324?  Also, the surgeons are saying "distal hypospadias", so is the ICD-10-CM code for this be Q54.8 or something else?  Thank you!!!


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## liqgold2@aol.com

A better diagnosis would be Q54.0 for a distal hypospadias. Bill what seems to have been done. 54324 is for a simple urethroplasty, flip V flap, a  meatal advancement, or preputial flaps, to form a urethra; while 54326 is for a more complicated urethroplasty with some  mobilization of a native urethra and local skin flaps used to form the remaining urethra.


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