# Dorsal island blanket flap -- need HELP!!



## lamreed (Sep 22, 2011)

Hypospadias, Penile(uretrhoplasty) 
Dr did 54324 (1-stage distal hypospadias repair with urethroplasty) but op-report also indicates "A dorsal island blanket flap was harvested and brought to the ventral side of the penis in the manner of Hodson and the epithelium was excised.  the blanket flap was tacked over the urethral repair w interrupted....
I'm not sure how to code this...  a coworker says to use 15120 but I'm not sure this is the correct code to use since the 54324 indicates it includes flap -- coworker states since op- report indicates "harvested"  this means its a free-flap or a graft.  So how should we code??


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## Kelly_Mayumi (Sep 23, 2011)

Is this to cover the urethroplasy to prevent a fistula from forming?


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## lamreed (Sep 23, 2011)

I don't know this is all the info I have:  

Following the induction of general anesthesia the adhesions of the foreskin to the glans were taken down and the pt was sterilely prepped and draped in the usual fashion.  A suture of 5-0 Prolene was passed through the glans and used as a traction stitch.  The lines of incision were maked out with a marking pen and infiltrated with 1% lidocaine...   The incisions were made sharply and the penis was sharply degloved, taking down tethering, chordee-type tissue to the penoscrotal junction.  The glans wings were raised sharply.  The urethral plate was incised in the midline & trimmed of deficient skin along the lateral aspects of the plate.  This was then tubularized over an 8 French feeding tube with a running subcuticular suture of 7-0 vicryl. The second layer was then placed with a running suture of 7-0 Vicryl.  A dorsal island blanket flap was harvested & brought to the ventral side of the penis in the manner of Hodson & the epithelium was excised.  The blanket flap was tacked over the urethral repair w interrupted 7-0 Vicryl sutures.  The glans wings were reapproximated w interrupted 6-0 Maxon sutures. The 8 French feeding tube was removed & a 6 French Kendall catherer was inserted.  The redundant foreskin was measured & marked out & sharply excised.  The skin edges were reapproximated w 7-0 vicryl.  The kendall catheter was secured w a suture of 5-0 Prolene in the glans cleft.  A Telfa and Tegaderm dressing was placed.


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## Kelly_Mayumi (Sep 28, 2011)

My groups uses 15740 for that.  Some insurances deny it and others don't.


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