Urology Coding Alert

Reader Questions:

Count Lysis of Adhesions in 54163

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 SubscriberAnswer: 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.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Urology Coding Alert

View All