Pediatric Coding Alert

Many insurance companies will not pay for a newborn circumcision in addition to a hospital visit. They will reimburse only for one code and deny the higher-paying code, the circumcision.
 
Usually a circumcision performed the same day of a subsequent hospital visit or on the discharge day is billed with the appropriate circumcision code (54160, circumcision, surgical excision other than clamp, device or dorsal slit; newborn, or CPT 54150 , circumcision, using clamp or other device; newborn) and E/M code (99433, subsequent hospital care, for the evaluation and management of a normal newborn, per day, or 99238, hospital discharge day management; 30 minutes or less) 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). To avoid losing revenue, perform the procedure in the office, which will eliminate billing a hospital visit.
Perform the Procedure in the Office  
After discharging the baby from the hospital, perform the circumcision in the office using 54160 or 54150. You will have the same problem billing a preventive-medicine services visit (99391) or a weight check for feeding problems (99212-99215) with the circumcision that you would have had billing the subsequent hospital visit (99433) or discharge (99238) with the circumcision. Ask the parent to bring the baby in specifically for the circumcision, and bill only that procedure on that day.
 
Note: Circumcision has a 10-day global, which could make billing for other services within that period difficult.
Penile Nerve Block  
Anesthesia should be used if circumcision is done. The AAP states that dorsal penile nerve block (64450*, injection, anesthetic agent; other peripheral nerve or branch) is very effective in reducing the behavioral and physiological indicators of pain caused by circumcision. Bill 64450* with 54150 or 54160.