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The procedure described by CPT® Code 53520 involves the surgical closure of a urethrostomy or urethrocutaneous fistula in males, classified as a separate procedure. A urethrostomy is an opening created in the urethra, while a urethrocutaneous fistula is an abnormal connection between the urethra and the skin. This surgical intervention is necessary to restore normal anatomy and function by closing these openings. The procedure begins with the placement of a catheter through the urethra to maintain urinary drainage during the operation. A midline incision is made at the urethral opening on the penile skin, allowing access to the fistula or urethrostomy. The surgeon excises the epithelialized tissue of the fistula or urethrostomy, inverting the urethral mucosa to facilitate proper closure of the defect. The surgical technique involves extending the incision proximally towards the scrotum to visualize the underlying dartos muscle, which is essential for creating a robust closure. The scrotal skin is then undermined, and a flap is marked and excised from the dartos muscle, which is elevated and positioned over the closure site. This flap is secured with sutures, and the dartos muscle is approximated and sutured in place. A drain may be placed to prevent fluid accumulation, and the skin layers are closed without tension to ensure optimal healing. The Foley catheter remains in place postoperatively to assist with urinary drainage during recovery.
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The closure of a urethrostomy or urethrocutaneous fistula is indicated in the following situations:
The procedure for the closure of a urethrostomy or urethrocutaneous fistula involves several detailed steps:
After the closure of the urethrostomy or urethrocutaneous fistula, patients can expect specific post-procedure care. The Foley catheter will remain in place to facilitate urinary drainage, and it is important to monitor for any signs of infection or complications at the surgical site. Patients may be advised to avoid strenuous activities during the initial recovery phase to promote healing. Follow-up appointments will be necessary to assess the surgical site and ensure proper recovery. Any drainage from the surgical site should be monitored, and patients should be educated on signs of potential complications, such as increased pain, swelling, or unusual discharge.
| Short Descr | REPAIR OF URETHRA DEFECT | Medium Descr | CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX | Long Descr | Closure of urethrostomy or urethrocutaneous fistula, male (separate procedure) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 109 - Procedures on the urethra |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| Pre-1990 | Added | Code added. |
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