How To Use CPT Code 54380

CPT 54380 describes a plastic operation on the penis to correct epispadias distal to the external sphincter. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 54380?

CPT 54380 is used to describe a plastic operation on the penis to correct epispadias distal to the external sphincter. Epispadias is a congenital malformation where the urethra ends in an opening on the top or upper side of the penis instead of at the tip. This condition can lead to various complications such as urinary tract infections, abnormal curvature of the penis, incontinence, and reflux nephropathy.

2. Official Description

The official description of CPT code 54380 is: ‘Plastic operation on penis for epispadias distal to external sphincter.’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider creates the urethral wall by reapproximating tissue and using various techniques such as skin grafts, tube grafts, free tissue grafts, or a combination of these methods.
3. An incision is made at the tip of the penis to create a meatal opening.
4. The external defect on the penis is repaired using local skin grafts and flaps.
5. The incision is closed with sutures.

4. Qualifying circumstances

CPT 54380 is performed on patients with epispadias distal to the external sphincter. The procedure is indicated for individuals who require correction of this congenital malformation. The patient must have a documented diagnosis of epispadias and be under the care of a qualified healthcare professional.

5. When to use CPT code 54380

CPT code 54380 should be used when a plastic operation is performed on the penis to correct epispadias distal to the external sphincter. It is important to ensure that the procedure meets the specific criteria outlined in the official description of the code.

6. Documentation requirements

To support a claim for CPT 54380, the healthcare professional must document the following information:

• Patient’s diagnosis of epispadias
• Description of the procedure performed
• Details of any grafts or flaps used
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 54380, ensure that the procedure meets the specific criteria outlined in the official description. It is important to accurately document the procedure and any additional services provided. Review the payer’s guidelines for any specific requirements or modifiers that may be necessary for proper reimbursement.

8. Historical information

CPT 54380 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with epispadias undergoes a plastic operation on the penis to correct the malformation distal to the external sphincter.
2. A healthcare professional performs a surgical procedure to repair the urethral wall and create a meatal opening for a patient with epispadias.
3. A plastic surgeon uses skin grafts and flaps to repair the external defect on the penis of a patient with epispadias.
4. A patient with epispadias undergoes a plastic operation to correct the malformation and improve urinary function.
5. A healthcare professional performs a plastic operation on the penis to correct epispadias and prevent complications such as urinary tract infections.
6. A patient with epispadias undergoes a surgical procedure to reapproximate tissue and create a functional urethra.
7. A plastic surgeon repairs the external defect on the penis of a patient with epispadias using local skin grafts and flaps.
8. A healthcare professional performs a plastic operation on the penis to correct epispadias and improve the patient’s quality of life.
9. A patient with epispadias undergoes a surgical procedure to create a meatal opening at the tip of the penis and repair the urethral wall.
10. A plastic surgeon uses various techniques to repair the malformation of the penis in a patient with epispadias.