Pediatric Coding Alert

Question: Our pediatricians often perform lysis of penile adhesions post circumcision in the office. Can we report the lysis with 54162?

Utah Subscriber

Answer: Check if the lysis involves instrumentation and general anesthesia.

No: If the physician can easily manually break down the postcircumcision adhesions (usually filmy lesions) without using an instrument to cut the adhesions, consider the work part of the office visit (99201-99215).

Yes: For lysis of postcircumcision adhesions performed with an instrument under sterile conditions, use 54162 (Lysis or excision of penile postcircumcision adhesions) linked to 605 (Redundant prepuce and phimosis). The procedure requires pain relief, such as a local anesthetic block, as well as general anesthesia to surgically release the skin bridge that has formed on the circumcision incision line. Because tissues bleed more freely at older ages and the physician must manage postoperative pain, the lysis requires more skill than the earlier postcircumcision service.

An alternative to 54162 is 54450 (Foreskin manipulation including lysis of preputial adhesions and stretching). Use this code if the foreskin is still partially adhered to the penis and creates problems (which usually occurs in children older than seven or adults).

--Information for/answers to You Be the Coder and Reader Questions provided/reviewed by Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine, Department of Pediatrics at Childrens Healthcare of Atlanta at Egleston; Charles Scott, MD, FAAP, pediatrician at Medford Pediatric and Adolescent Medicine in New Jersey; Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville; and Melanie Witt, RN, CPC, COBGC, MA, in Guadalupita, N.M.