Urology Coding Alert

Reviewed on May 27, 2015
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. [...]