Pediatric Coding Alert

Question: On date of service 7/20, our pediatrician removed digits from a newborn’s right and left hands and right and left feet — no bone was removed during the procedure. Then 7/21, she performed a circumcision with a 99462, which was followed by a discharge on 7/22 that lasted less than 30 minutes. I want to bill:

26587-F4

26587-F9

26587-T4

26587-T9

99462-24

54150-59

99238-24

Is this correct?

Codify Subscriber

Answer: There are three main problems with this way of describing the services your pediatrician provided.

First, 26587 (Reconstruction of polydactylous digit, soft tissue and bone) incorrectly represents the procedure your pediatrician performed on the newborn on 7/20. As the code descriptor states, this minor surgery involves removing bone as part of the reconstruction which, as you state, did not occur. Extra digit removal that occurs before the digit is fully formed is coded the same way you would code skin tag removal, using 11200 (Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions). You would not need to use multiple units of the code, as again, per this code’s descriptor, you can use it to document removal of all four digits. This would also preclude using the digit location modifiers.

Next, for the 7/21 date of service (DOS), you can use 54150 (Circumcision, using clamp or other device with regional dorsal penile or ring block) and 99462 (Subsequent hospital care, per day, for evaluation and management of normal newborn) as you propose. However, you can bill both without modifier 24 (Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period) or 59 (Distinct Procedural Service) as there are no National Correct Coding Initiative (NCCI) edits to prevent the codes from being billed together.

Lastly, your use of modifier 24 on 99238 (Hospital discharge day management; 30 minutes or less) is also unnecessary, as the service was performed on a different date from the other services you are reporting.

This leaves you with:

• 11200
• 99462
• 54150
• 99238

as a more accurate way of representing your pediatrician’s workload for the DOS you indicate.