Urology Coding Alert

Question: In our coding software, the description of CPT 54380 indicates that this procedure involves "using skin grafts, tube grafts, free tissue grafts, or a combination of techniques depending on the extent of the defect." The urologist used a buccal mucosal graft (40818) and an acellular xenograft (15430, attached with sutures) during the repair. There are no CCI coding conflicts between any of these three codes. Can I code for these grafts separately despite what the lay descriptions in the coding software say?

Massachusetts Subscriber

Answer: Since there are no Correct Coding Initiative (CCI) bundling edits between these three codes, you should report all three for this procedure.

Code 40818 (Excision of mucosa of vestibule of mouth as donor graft) is for the harvesting of buccal mucosa for an inlay and certainly is a billable service along with the repair, 54380 (Plastic operation on penis for epispadias distal to external sphincter).

Reporting 15430 (Acellular xenograft implant; first 100 sq cm or less, or 1 percent of body area of infants and children) with 54380 may be somewhat controversial, but since this is an extra body graft (a porcine graft), you should report this procedure too. Your reimbursement success will likely depend on the payer's interpretation of these codes.

Your coding should look like this:

Modifiers: You should attach modifier 51 (Multiple procedures) to the latter two procedures to indicate to the payer that your urologist performed those services as separate procedures on the same patient at the same session.