Urology Coding Alert

Question: My provider removed a Plastibell in the office. He is not the provider who performed the circumcision. I know that normally this would be covered under the E/M but he feels it should be billed separately since he was not the provider who performed the procedure. Have you seen this issue before?

Vermont Subscriber

Answer: There is no CPT^® code for the Plastibell removal. A better option is to include it as part of the E&M service. If your provider spends more time talking to the patient/family about the procedure, your E/M code could possibly reflect a higher level of service.

If the Plastibell removal was within the global time of the circumcision, you will not get paid by the insurance company. You can bill the E/M service, but you should also alert the patient (or insured party) that they would be responsible for the visit because insurance will not pay for it.

Another scenario: If you're working with a Medicare patient, get a signed advance beneficiary notice (ABN) before the procedure acknowledging that the patient is responsible for anything Medicare doesn't reimburse. Some practices handle this by having the patient see the surgeon during the postoperative period and stating that your provider will gladly see the patient after that time for any other follow-up care.