Urology Coding Alert

Selection of the most appropriate CPT® code forthe treatment of phimosis or paraphimosis can be tricky. Although the procedures differ significantly, they share a diagnosis code (605, Redundant prepuce and phimosis) and similar treatments.

For ICD-10, they do not share a diagnosis code. You’ll report a code in the N47 range, based on the type of disorder.

Two treatments — circumcision and dorsal slit — are used to correct a phimosis or a paraphimosis. Reduction is also performed to treat a paraphimosis. You should choose the procedure code based on the type of treatment and link 605 to the procedure.

When an adult circumcision other than clamp is performed to treat phimosis or paraphimosis, you should report 54161 (Circumcision, surgical excision other than clamp, device or dorsal slit; older than 28 days of age).

 

Paraphimosis may also be treated by a reduction of the paraphimosis back over the glans; use 54450 (Foreskin manipulation including lysis of preputial adhesions and stretching).

If a dorsal slit is performed to treat a phimosis or a paraphimosis, you should report 54001 (Slitting of prepuce, dorsal or lateral [separate procedure]; except newborn), which has a 10-day global period.

 

Circumcision Includes Reduction

 

A reduction of the paraphimosis before the circumcision is not chargeable because 54450 is bundled into 54161. This bundle cannot be broken with a modifier. If the physician spends an unusual amount of time on the reduction, performs the circumcision and documents the time in the operative note, append modifier 22 Increased procedural services) to 54161, says Morgan Hause, CCS, CCS-P, coding specialist with

Urology of Indiana in Indianapolis. Using modifier 22 too often can trigger an audit, so use it judiciously.

 

Code 54450 may be used in the hospital or office setting. For example, a urologist consults a hospitalized elderly gentleman for a swollen penis. He examines the patient and reduces a paraphimosis. Code the consultation with 9925x appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and the reduction with 54450.

 

In another example, a urologist manually lyses preputial adhesions on a young uncircumcised male. You should report 54450 for the manipulation.

 

Note: Codes 54000 (Slitting of prepuce, dorsal or lateral [separate procedure]; newborn) and 54001 (except newborn) are bundled into 54450 (manipulation) and cannot be unbundled. Circumcision (54161) has a 10-day global and includes 54001. No unbundling is allowed.

 

Sometimes, a circumcision is performed after the reduction, but within the global period. For example, a patient presents to the emergency department with a severe degree of paraphimosis and swelling. A urologist manually reduces the paraphimosis and admits the patient. The next day, the patient undergoes a dorsal slit procedure. Three days later, after the resolution of the penile edema, a circumcision is performed. For day one report 9922x-25 (Initial hospital care) and 54450 (0-day global); for day two report 54001 (10-day global); and for day five report the circumcision (54161) with modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professionalduring the postoperative period) appended. Because the circumcision is performed within the global period of 54001, modifier 58 is required to break the bundle.