Pediatric Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Our pediatrician performs circumcision with penile nerve block at the office. We are coding CPT 54160 and 64450-51 (Multiple procedures). Payers are denying the payment for nerve block, stating that it is incidental to the circumcision, even though we emphasize that it is a starred procedure. Is there anything else we can do? Florida Subscriber   Answer: You are correct that the dorsal penile nerve block or ring block (64450*, Injection, anesthetic agent; other peripheral nerve or branch) is not incidental to the circumcision (54160, Circumcision, surgical excision other than clamp, device or dorsal slit; newborn), and you should fight any denials with resources that support this position.

"Report both procedures, and bill out on a paper claim," says Mary Gutierrez, CPC, a certified pediatric coding specialist for West Texas Medical Associates in San Angelo. "Include the doctor notes, a copy of the Correct Coding Initiative (CCI) edits that show the procedures are not bundled, and a copy of the CPT guidelines for a starred procedure."

You can streamline appeals for common denials without having to sacrifice the ease of electronic filing, says Victoria S. Jackson, CEO of Southern Orange County Pediatric Associates and owner of Omni Management, which provides practice management services for 15 medical offices in the Los Angeles area. For each common denial, such as dorsal penile nerve block, group the appropriate paperwork, such as copies of the applicable CPT codes and any CCI edits, with a form letter. When you receive a denial, pull that paperwork plus the evaluation of benefits and send the information to the director of insurance. "If you barrage the insurance company, it may stop repeating the denial, allowing you to eliminate the extra paperwork," Jackson says. A phone call to the payer's medical director may also help.

Remember, modifier -51 typically reduces the reimbursement for the second procedure by 50 percent. So ask your carrier if it requires the modifier. You should append modifier -51 to the nerve block code instead of the circumcision code because the reimbursement is less for 64450 than for 54160.