Penile Adhesions

Hi,
We are looking for direction on coding manual lysis of adhesions with EMLA cream.
 
Per CPT Coding Essentials Urology and Nephrology 2022 edition:
CPT 54162: Lysis or excision of penile post-circumcision adhesions notes “persistent adhesions may be cut (lysed) or excised” and “a general, regional or local anesthetic is administered. A scalpel is then used to lyse or excise the adhesions”.
CPT 54450: Foreskin manipulation including lysis of preputial adhesions and stretching notes “the foreskin is manually manipulated”.
 
When EMLA cream (local analgesia) is applied and lesions are manually lysed what is the most appropriate code? Some feel because analgesic is applied this would be coded 54162 while others feel 54162 requires the use of an instrument for cutting and manual lysis of adhesion is more appropriately coded 54450 whether EMLA is applied or not.
 
Your help and insight is greatly appreciated to capture these procedure correctly.

re: Penile Adhesions

EMLA is a topical cream used to prevent pain before the procedure to temporarily numb the area, such as before an injection using lidocaine and prilocaine.  EMLA cream is generally applied an hour prior to the procedure or injection. 
 
EMLA may be used to prepare the site prior to the anesthetic, but the determining factor in code selection is the method of the procedure. If a sharp instrument (excision) is used or destruction (Lysis), then 54162 is more appropriate whether EMLA is applied or not.
 
54450 includes lysis but not excision. Was the procedure done with manual manipulation by the physician to break up adhesions? If the procedure were manual, 54450 would be the correct code. 
 
Both codes are found under Surgical Procedures on the Penis however:
 
54162 is under the section "Excision Procedures on the Penis"
and 
54450 is under the section "Manipulation Procedures on the Penis"
 
The determining factor should be found in the surgeon’s documentation. The use of EMLA has no relationship and will not determine the procedure.  If the documentation is unclear, you will need to query the provider.