# Penile fracture 54440 vs 55899



## tgenia (May 30, 2014)

Hi, I need your expert advice!! I was leaning towards the unlisted 55899 since the 54440 doesn't quite fit the body of the the procedure completed. Any help would be great.

PREOPERATIVE DIAGNOSIS
Penile fracture.

POSTOPERATIVE DIAGNOSIS
Penile fracture.

PROCEDURE
Repair of penile fracture.

ANESTHESIA
General. 

INDICATION
See history and physical by me.

DESCRIPTION OF PROCEDURE
The patient underwent general anesthesia. He was prepped and draped in
sterile fashion. I performed a penile block with 16 mL of 0.5% Marcaine at
the base of the penis. There was a large hematoma over the distal shaft of
the penis, especially ventrally. I made an incision through his previous
circumcision incision, just under the corona of the glans penis, and
encountered a large amount of hematoma. I degloved the penis, dissecting the
skin all the way back to the base of the penis. After removing the hematoma,
I identified a 1.5 cm long tear in the tunica albuginea of the left corpus
cavernosum, beginning all the way up under the glans penis and extending
proximal to this. It was directly adjacent to the urethra, only about 2 mm of
tunica albuginea for me to place sutures in alongside the urethra. Therefore,
I decided that rather than using a larger PDS suture, I would need to use a
smaller Vicryl suture in order to use a smaller needle and in order to have
a more rapidly absorbing suture and smaller knot going right next to the urethra. There was no
damage to the urethra itself. I closed the defect with a running 3-0 Vicryl
suture. This gave excellent control of bleeding and appeared to be a good
repair. I then pulled some subcutaneous tissue up over this and closed that over it. I
looked for hemostasis, which was excellent. I reclosed the skin with
interrupted 3-0 Vicryl. I should mention that I did place a Foley catheter at
the beginning of the procedure, which was helpful in identifying the urethra,
and decided to leave it overnight postoperatively. After closing the skin, I
applied bacitracin ointment, sterile gauze dressing, and a Coban pressure
dressing over this. He was awakened from anesthesia and went to the recovery
room in good condition.

We will remove his catheter tomorrow. We will leave his pressure dressing on
for at least a couple of days. He will be going back to Montana in a couple
of days and will need to have a urologist there.


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## ninaleeth@hotmail.com (May 31, 2014)

*Recommend 54440*

Even though 54440 is not terribly descriptive, it is a "plastic repair of the penis".  According to the "Coders Desk Reference for Procedures", "The Physician repairs an injury of the penis using one or more of plastic surgery techniques.  The repair may require skin grafts, tissue grafts, urethral repair, extensive debridement, microsurgical repairs, or any combination."  

Therefore, I believe that your surgeon's treatment would definitely fall under that description.  I would avoid the unlisted procedure unless you have no choice.  However, I believe that the 54440 is correct in this case.


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