Urology Coding Alert

Question: Would it be appropriate to bill CPT 54163 and CPT 54162 -59? My urologist wants to bill both codes: 54163 for the redundant foreskin and 54162 for the adhesions for a patient with an incomplete previous circumcision.

Iowa Subscriber

Answer: You should bill 54163 (Repair incomplete circumcision) alone.

You should not also report 54162 (Lysis or excision of penile post-circumcision adhesions) because payers consider the lysis of adhesions before a circumcision or repeat circumcision included and bundled into 54163.

Here's why: Surgically speaking lysis of adhesions is part of the circumcision, basically preparing the operative site for the circumcision. Adding modifier 59 (Distinct procedural service) to try and receive payment for the lysis is unbundling the surgical procedure itself.