Primary Care Coding Alert

Question: If we bill 54150 for a circumcision, can we also report 64450 for the accompanying nerve block? If so, should we append modifier 47 to 64450?


Texas Subscriber

Answer: The AMA has revised 54150 (Circumcision, using clamp or other device with regional dorsal penile or ring block) in the new edition of CPT 2007 to include the accompanying nerve block in the description of the service. As such, it would be inappropriate to report 64450 (Injection, anesthetic agent; other peripheral nerve or branch) with 54150 for this purpose, and the National Correct Coding Initiative (NCCI) bundles 64450 into 54150 for this reason.

Because the NCCI edit carries an indicator of -1,- physicians can append a modifier (such as modifier 59, Distinct procedural service) to 64450 along with documentation showing that they used 64450 as regional anesthesia for other reasons.

You do not need to append modifier 47 (Anesthesia by surgeon) to 54150.