Urology Coding Alert

These new CPT codes put you in the winner's circle every time
 
Urology coders have long had to combat denials for nerve blocks performed with circumcisions. But you can now cross this common hurdle off your list of coding headaches, thanks to CPT Codes 2007, effective Jan. 1.

Bonus: Codes 54150-54152 and 54160-54161 also undergo major revisions and deletions that will make coding circumcisions easier. 

Stop Reporting 64450 With CPT 54150

In the past, you've had to try to overcome bundling rules that carriers place on nerve block procedures to get paid for both the anesthesia and the circumcision
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Trouble spot: Despite CPT's surgical package that bundles digital blocks, not nerve blocks, into a procedure, "many payers continued to deny payment of the penile nerve block inappropriately," states the AMA in CPT Changes: An Insider's View 2007. Even when appeals reference CPT Assistant August 2003, which clearly states that "a penile nerve block is not considered a local infiltration or topical anesthesia," insurers still bundled 64450 (Injection, anesthetic agent; other peripheral nerve or branch) into circumcision code 54150.

New rule: "The revised language of 54150 now makes the nerve block part of the procedure," says Richard H. Tuck, MD, FAAP, a national pediatric coding speaker and educator who is a pediatrician at PrimeCare of Southeastern Ohio. Regardless of a modifier, you should not report 64450 in addition to 54150 on claims dated Jan. 1, 2007, and later.

Impact: You'll no longer have to fight for separate 64450 payment because it will now be included automatically in 54150.

Don't overlook: When you perform 54150 without a dorsal penile or ring block, you should indicate this circumstance with modifier 52 (Reduced services). "You'll have to use modifier 52 on 54150 to indicate reduced services," Tuck says. Reporting 54150-52 will result in some reduction in your billed charge as compared to 54150, which will include the block.

Use 54150 for All Nonsurgical Circs

If you perform circumcisions using a clamp or other device on patients who are not newborns, you won't have to switch from 54150 to 54152, says Victoria S. Jackson, practice management consultant with JCM Inc. in California. "You'll have one universal nonsurgical circumcision code."

The AMA compresses the two nonsurgical circumcision codes into one code, without age restrictions:

• Revised code: 54150 -- Circumcision, using clamp or other device with regional dorsal penile or ring block

• Deleted code: 54152 -- Circumcision, using clamp or other device; except newborn. "To report, use 54150," according to the parenthetical instruction following 54150 in the CPT 2007 manual.

Apply 28-Day Age Restriction to 54160-54161

You can look forward to never again stumbling over the term "newborn" when coding a surgical circumcision (54160 and 54161). CPT 2007 revises the surgical circumcision codes to clarify the patient's age.

How it works: Starting Jan. 1, 2007, use 28 days as the timeframe for choosing between the surgical circumcision codes. Here's how:

• Revised code: For a surgical circumcision of a patient who is 28 days of age or younger, assign 54160 (Circumcision, surgical excision other than clamp, device or dorsal slit; neonate [28 days of age or less]).

• Revised code: Report surgical circumcision of males older than 28 days of age with 54161 (... older than 28 days of age). Note that this includes adults.

Note: Some of the surgical excision circumcision codes did not change. Also, the 28-day rule has always been the coding definition for newborns, especially in relation to diagnosis coding. This makes the definition clear to payers.