Pediatric Coding Alert

Question: Documentation indicates the following: PREOPERATIVE DIAGNOSIS(ES)/INDICATION: Redundant foreskin POSTOPERATIVE DIAGNOSIS(ES): Circumcised penis RESIDENT PERFORMING PROCEDURE (if any): Resident

PROCEDURE AND FINDINGS:An informed consent was obtained by myself or my partner. I reviewed the document with the parent(s), verified that it was signed, and gave the parent(s) the opportunity to ask further questions.

A time-out procedure was completed, verifying correct patient, procedure, site, positioning, and, or special equipment if applicable.

The infant was placed on a restraining board, prepped and draped in a sterile fashion. Local anesthetic was applied as follows:

ANESTHETIC AGENT: EMLA

GOMCO CLAMP SIZE:1.3.

The adhesions between the glans and the foreskin were separated by blunt dissections. A dorsal slit was made and the Gomco circumcision clamp was applied in the usual manner. The clamp was left on for 5 minutes for hemostasis. The foreskin was then excised with a scalpel and the clamp was removed. No active bleeding was noted. The infant was dressed in a double diaper with Vaseline applied as a pressure dressing. The infant was returned to the mother in good condition. A circumcision care handout was provided to the parents.

ATTENDING ADDENDUM:

I completed the entire procedure myself or was present as the teaching attending for the entire procedure.

SIGNED: Dr. Attending DATE: 04/04/09

Should I bill for the EMLA (eutectic mixture of local anesthetics) cream (lidocaine/prilocaine) that was applied to the penis before the resident performed the circumcision? If yes, what HCPCS code should I use?

Ohio Subscriber

Answer: The EMLA application is not a separately billable procedure. You should include the topical anesthetic in 54150 (Circumcision, using clamp or other device with regional dorsal penile or ring block). CPTs surgical package definition always includes local infiltration,metacarpal/ metatarsal/digital block or topical anesthesia in a given CPT surgical code in addition to the operation.

Dont forget: Because the resident performed the circumcision without a dorsal penile or ring block, you must append modifier 52 (Reduced services) to 54150,according to CPTs parenthetical direction following 54150. To indicate a resident provided the procedure under a teaching physicians direction, youll also need modifier GC (This service has been performed in part by a resident under the direction of a teaching physician).

In summary, youll report 54150-52-GC linked to V50.2 (Elective surgery for purposes other than remedying health status; routine or ritual circumcision).Always list a payment affecting modifier (for instance modifier 52) before an informational one, such as GC.