Wiki Urethroplasty

[rgeib]

Looking for advisement second opinion for the following procedure:

"Procedure(s):​

CIRCUMCISION, PARTIAL PENECTOMY, GLANSPLASTY,　urethral mucosal advancement flap

The patient was brought to the operating room and laid on the operating table supine. 　General anesthesia was administered. 　Perioperative antibiotics were given. 　The entire was prepped and draped in the usual sterile manner. 　A hard stop timeout was completed.
​

Given the tender nature of the patient's penile area, a exam was performed. 　It appeared to be a thickened or hardened mass on the ventral aspect of the glans near the urethral meatus which could not be visualized. 　A dorsal slit was then conducted for better exposure. 　A beefy red slightly raised area approximately 2 cm x 1 cm x 0.5 cm was palpable surrounding the urethral meatus. 　This area transitioned to the ventral foreskin　in continuity. 　Decision was therefore made to excise the area with a slight margin of less than half a centimeter. 　Eventually in order to preserve the glans. 　A small piece was sent to pathology and returned as invasive carcinoma on frozen section. 　The dorsal aspect of the glans appeared normal if not slightly irritated, the ventral aspect however was then covered with some bleeding. 　The penile skin was reapproximated to the distal skin on the dorsal aspect however on the ventral aspect there is no skin to sew to. 　Therefore the urethra was mobilized and spatulated creating hypospadias affect but allowing be dorsal urethra to cover the ventral side of the glans. 　This was sutured to the glans using 4-0 Vicryl sutures. 　The skin was then sewed to the perimeter of the hypospadiac urethra in order to provide full epithelialized coverage of the exposed ventral glans that had been resected."

Proposed coding is 14040, 11622-59 and 12041-59. The penectomy was not coded as the excision of tissue did not fit the description for this code set. The glansplasty was also not coded due to the fact that this was performed due to there not being enough skin from the removal of the malignancy. Therefore, the tissue transfer code along with the excision code and the intermediate repair were reported instead.

Any help is appreciated. Thank you in advance.

 

[liqgold2@aol.com]

Although this procedure was complicated, and the documentation was somewhat difficult to understand, I would accept the coding as you described in explanation. I would also code for a circumcision, 54161, and 53450 for the urethral advancement as mentioned in the procedures performed. I agree that a partial penectomy was not performed although mentioned in the report.