Forum - Questions & Answers

Jun 23rd, 2014 - macsmeme

CPT® code 54162 and 54163

Would you bill these two CPT® codes together? They are bundled per CCI edits but my physicians feel that these are separate procedures even though they are working in the same area. Thanks.

Jun 23rd, 2014 - behinkson 3 

re: CPT® code 54162 and 54163

Try adding a 59 modifier and appeal with records

Jun 23rd, 2014 - CodapediaMsgBoard 96 

re: CPT® code 54162 and 54163

Here is a resource on this that may help. Basically, in summary the payer would likely consider the lysis to be a part of the repeat circumcision.

That said, CCI will allow this edit combination to be bypassed by a modifier, but in that case the adhesions would likely have to be along the shaft. If it is in the same area, I'd expect that the 54162 would be bundled into the repair. My only worry with the use of 59 is that the payer would pay the claim (rather than require an appeal with documentation), but it would be an improper payment.

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