# Hypospadias Repair with circumcision and catheterization



## cbyrne@urologic-consultants.com (Jul 24, 2014)

Can someone please read this op note and tell me how you would code it? I have alot of rejections coming in for the way I am coding it and want to see others opinions?


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## Kelly_Mayumi (Jul 25, 2014)

What op note cbyrne?


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## pvacanti (Jul 30, 2014)

Adding the op note for cbyrne that we need help with coding:
Procedure:
Distal Hypospadias repair
Dartos Flap
Byars Flap
Complex catheterization
Circumcision

urethral meatus was noted to be in a subcoronal position and widely patent.  A U-Shaped incision was then marked, encompassing the urethral plate and extending proximal to the native urethral meatus. A filit skirt was then marked and cut dorsally and extended ventrally to meet the urethral incision. Then penis was degloved, leaving adequate ventral dartos tissue for later creation of a barrier flap. With the penis degloved, an artificial erection was administered. The patient was noted to have straight phallus. The glans wings were then infiltrated with dilute epinephrine and cut. With the glans wings then cut the urethral plate was incised deeply in the midline.  A 6-french urethral catheter was then placed and secured in place. Urethroplasty was performed over the catheter using absorbable suture in 2 layers in a running fashion.  With the urethroplasty then completed, a ventral dartos flap was then raised and secured over the urethroplasty using absorbable suture in a interrupted fashion. With the glansplasty complete, the previously cut Firlit skirt was rotated ventrally, cut to length, and anastomosed in the midline using absorbable sutures in an interrupted fashion. With the micolsal collar then recreated, Byars' flaps were cut dorsally and rotated ventrally to cover the ventral skin defect. They were anastomosed in the midline using absorbable suture in an interrupted fashion. Excess prepuce was then excised to complete the circumcision. The proximal and distal aspects of the circumcision were anatomosed using absorbable suture in an interrupted fashion. 
Thank you for any help!!!!


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## Kelly_Mayumi (Aug 4, 2014)

I think this is 54234.  Does the surgeon call it anything else, like a snodgrass or magpi, for example?  I have heard from pediatric urologists, hypospadious repair codes do not reflect the technique and advancment of treatment options for this condition so it is difficult to choose codes for the repairs.


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