Urology Coding Alert

Question: It is my understanding that circumcisions done within the 48/96 hour time frame are billed under the mom’s insurance number using “baby boy” Smith (or whatever the last name is) as the patient. Can you confirm whether this is correct?

New Jersey Subscriber

Answer: This can be true for billing from the hospital perspective with a UB04 form. If you’re billing for the physician, the baby must be added to the parent’s insurance plan and have a name that’s not “baby boy.” However, you are permitted to use “baby boy” for government plans such as Medicaid, Peach State, Wellcare, or Amerigroup because the baby will have his own ID number.

Your code choices for the procedure on a neonate are 54150 (Circumcision, using clamp or other device with regional dorsal penile or ring block) and 54160 (Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate [28 days of age or less]). Base your code choice on the physician’s technique used.