Pediatric Coding Alert

This months column is by Richard H. Tuck, MD, FAAP, a member of the American Academy of Pediatrics (AAP) committee on coding and reimbursement and consulting editor of this newsletter. Tuck practices with Primecare Pediatrics in Zanesville, Ohio.

When it comes to reimbursement, its a surgeons world. This is a product of traditional indemnity insurance plans, which allowed for inflated fees for procedures. But pediatricians who use only the evaluation and management (E/M) services codes are cheating themselves.

My plea is that pediatricians capitalize on procedures that they do, and stretch themselves to do procedures they might be uncomfortable doing because they are used to referring to specialists. For many of these procedures, pediatricians dont need to referthey can do these procedures themselves. Here are my recommendations for procedures that pediatricians should perform:

1. Circumcisions. Many pediatricians dont do circumcisions. I strongly feel we should because we do the education and the follow-up. Circumcision code 54150 (circumcision, using clamp or other device; newborn), has a fee range from $127 to $164, while CPT 54160 (circumcision, surgical excision other than clamp, device or dorsal slit; newborn) has a fee range from $212 to $257.

Because pediatricians dont do the procedure until the infant is ready, they are able to provide better care than other providers might offer. Performing the circumcision in the hospital instead of the office also has the benefit of the hospital absorbing the cost of the practice expense: the nurse, the circ tray, antibiotic ointment, etc.

2. Wart removal. Code 17110* (destruction by any method of flat warts, molluscum contagiosum, or milia; up to 14 lesions) fee ranges from $71 to $87. Some pediatricians dont do this because they are afraid of using the liquid nitrogen. Even in our office, four of us use it, but one isnt comfortable with it. If you dont have liquid nitrogen or another method of treating warts, you are losing money unnecessarily every time you refer these children to dermatologists.

This is a starred procedure, which means you can charge an office visit at the same time. But you have to use a modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) on the office visit in order to get paid under CPT 2000 rules.

3. Chemocauterization of umbilicus. Code 17250* (chemical cauterization of granulation tissue [proud flesh, sinus, or fistula]) fee ranges $67 to $81. Sometimes the pediatrician needs to destroy excessive healing tissue known as proud flesh. Silver nitrate is used.

If you neglect to bill for this procedure, you are denying your practice deserved reimbursement. This is a starred procedure, so you [...]