Pediatric Coding Alert

Question: Other pediatricians who do not perform circumcisions ask me to do the circumcisions in my office. I make sure the infant is OK. If he is, I go and ahead and perform the nonsurgical circ with ring block on the same day. Am I right to code a consult and a circumcision?

Colorado Subscriber

Answer: If your documentation supports both services and the consultation meets the service's requirements, you may code a consultation (99241-99245, Office or other outpatient consultation ...) and the circumcision (54150, Circumcision, using clamp or other device with regional dorsal penile or ring block). The medical record would need to contain complete documentation of the preoperative consultation and a separate note for the circumcision.

Consult requirements: The requesting physician must request your opinion and state the reason he's asking for it. Although the other pediatric practices can make the request verbally, it must appear in the chart. For instance you could document a request made over the phone in the chief complaint with the notation, "The child presents today at the request of Dr. Ped West for a preoperative clearance consultation to make sure he can undergo circumcision."

In addition after rendering your findings, you must send a report back to the requestor. You send back a letter indicating, "I've examined Baby Joey and determined that he can withstand the ring block and the procedure. I am therefore proceeding with circumcision."

To indicate the E/M service is above and beyond the usual pre- and postoperative care the circumcision includes, you may need to use modifier 25 (Significant, separately identifiable evaluation and management service on the same day of the procedure or other service) on the consultation code. Most payers follow Medicare's rule that restrict modifier 57 (Decision for surgery) to procedures that have 90-day global periods. Code 54150 has a zero-day global period, which means the procedure includes related same-day pre- and postoperative services, according to the 2008 Medicare Physician Fee Schedule.

Link 9924X-25 to V72.84 (Preoperative examination; unspecified). Then, link 54150 to V50.2 (Routine or ritual circumcision).

Reality: Insurers may include the E/M service with the circumcision.