toria11
Guru
Would the following be billed as a circumcision revision or excision of penile adhesions? I read that a "skin bridge" is just another term for adhesions but I want to be sure. Thanks!
POSTOPERATIVE DIAGNOSIS: Penile adhesion/skin bridge post circumcision.
INDICATIONS FOR PROCEDURE: The patient is a 48-year-old male history of circumcision of at
birth with a broad skin bridge dorsally. He requested this to be resected due to discomfort.
DETAILS OF PROCEDURE: The patient was taken to the operating room and positively identified as
well as the side of surgery during a time-out. After adequate MAC anesthesia, he was prepped and
draped in the usual sterile fashion for circumcision revision. Prior to releasing the skin bridge, a ring and
dorsal nerve block was performed. Skin bridge was dissected from the underlying prep used with moist
and hemostats. The skin bridge was then divided with a needle tip Bovie taking care to preserve the
coronal sulcus. Once skin bridge was released, the skin retracted in line with the foreskin and prepuce.
There is small amount of redundant skin along the corona. The transected tissue along the corona did not
need and to be reapproximated. It was cauterized and covered with antibiotic ointment. The skin then
retracted in line with prepuce and was closed in interrupted 4-0 chromic stitches. Antibiotic ointment was
applied to that area, and then we covered both areas with a sterile dressing. Hemostasis was excellent.
The patient tolerated the procedure well without complications.
POSTOPERATIVE DIAGNOSIS: Penile adhesion/skin bridge post circumcision.
INDICATIONS FOR PROCEDURE: The patient is a 48-year-old male history of circumcision of at
birth with a broad skin bridge dorsally. He requested this to be resected due to discomfort.
DETAILS OF PROCEDURE: The patient was taken to the operating room and positively identified as
well as the side of surgery during a time-out. After adequate MAC anesthesia, he was prepped and
draped in the usual sterile fashion for circumcision revision. Prior to releasing the skin bridge, a ring and
dorsal nerve block was performed. Skin bridge was dissected from the underlying prep used with moist
and hemostats. The skin bridge was then divided with a needle tip Bovie taking care to preserve the
coronal sulcus. Once skin bridge was released, the skin retracted in line with the foreskin and prepuce.
There is small amount of redundant skin along the corona. The transected tissue along the corona did not
need and to be reapproximated. It was cauterized and covered with antibiotic ointment. The skin then
retracted in line with prepuce and was closed in interrupted 4-0 chromic stitches. Antibiotic ointment was
applied to that area, and then we covered both areas with a sterile dressing. Hemostasis was excellent.
The patient tolerated the procedure well without complications.