Pediatric Coding Alert

Shocker: CPT 2007 ends your nerve block nonpayment woes

When CPT 2007 takes effect Jan. 1, it will usher in a new age: You'll no longer have to fight for pay for a nerve block with a circumcision.

"The biggest CPT 2007 change for pediatricians is a revamping of the circumcision codes," says Richard H. Tuck, MD, FAAP, a national pediatric coding speaker and educator. Codes 54150-54152 and 54160-54161 will undergo major revisions and deletions, as described in the following chart, which also indicates what page to turn to for details on that change.

Stop Reporting 64450 With 54150

Pediatric Coding Alert experts and readers have long offered tips to combat denials for nerve block with circumcision. But you can now cross off this common bundle from your to-appeal list.

Trouble spot: Despite CPT's surgical package that bundles digital blocks, not nerve blocks, into a procedure, "many payers continued to deny payment of the penile nerve block inappropriately," states the AMA in CPT Changes: An Insider's View 2007. Even when appeals reference CPT Assistant August 2003, which clearly states that "a penile nerve block is not considered a local infiltration or topical anesthesia," insurers still bundle 64450 (Injection, anesthetic agent; other peripheral nerve or branch) into nonsurgical circumcision code 54150

Change 1: "The revised language of 54150 now makes the nerve block part of the procedure," says Tuck, who is a pediatrician at PrimeCare of Southeastern Ohio. Regardless of modifier, you should not report 64450 in addition to 54150 on claims dated Jan. 1, 2007, and later.

Impact: You'll no longer have to fight for separate 64450 payment. "This [revision] is good news for pediatricians ...," according to CPT Changes: An Insider's View 2007.

Don't overlook: When you perform 54150 without a dorsal penile or ring block, you should indicate this circumstance with modifier 52 (Reduced services). "You'll have to use modifier 52 on 54150 to indicate reduced services," Tuck says. Reporting 54150-52 will result in some reduction in your billed charge as compared to 54150, which will include the block.

Use 54150 for All Nonsurgical Circs

If you perform nonsurgical circumcisions on patients who are not newborns, you won't have to switch from 54150 to 54152, says Victoria S. Jackson, practice management consultant with JCM Inc. in California. "You'll have one universal nonsurgical circumcision code."

Change 2: The AMA compresses the two nonsurgical circumcision codes into one code, without age restrictions:

• Revised code: 54150 -- Circumcision, using clamp or other device with regional dorsal penile or ring block

• Deleted code: 54152 -- ... except newborn. "To report, use 54150," according to the parenthetical instruction following 54150 in the CPT 2007 manual.

Apply 28-Day Age Restriction to 54160-54161

You can look forward to never again stumbling over the term "newborn" when coding a surgical circumcision (codes 54160 and 54161). CPT 2007 will revise the surgical circumcision codes to clarify the patient's age.

Change 3: Starting Jan. 1, 2007, use 28 days as the timeframe for choosing between the surgical circumcision codes. Here's how:

• Revised code: For a surgical circumcision of a patient who is 28 days of age or younger, assign 54160 (Circumcision, surgical excision other than clamp, device or dorsal slit; neonate [28 days of ageor less]).

• Revised code: Report surgical circumcision of males older than 28 days of age with 54161 (... older than 28 days of age).