Urology Coding Alert

Question: A consultant said I should use modifier 52 when a urologist performs a neonatal circumcision without anesthesia. I thought the circumcision code now included anesthesia. Would you explain this advice?

Colorado Subscriber

Answer: CPT contains several codes for the performance of a circumcision, including 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]). Only 54150 includes anesthesia (64450, Injection, anesthetic agent; other peripheral nerve or branch).

Physicians commonly use circumcision using a clamp for neonatal circumcisions. In 2007, CPT revised 54150 to include the regional dorsal penile or ring block that physicians may administer prior to this type of circumcision. If a urologist uses this method of circumcision without a dorsal penile or nerve block, you should append modifier 52 (Reduced services) to 54150, says a parenthetical instruction following the code in the CPT manual.

Tip: Let the payer reduce payment for a lesser or reduced service that you may elect to perform. Do not reduce your charge on your submitted claim. Using the Medicare Physician Fee Schedule, 54150 pays about $197 in the office (5.19 RVUs x 2008 conversion factor 38.0870) and $106 in the hospital (2.79 RVUs x 38.0870).

Code 54160 does not include anesthesia (64450), which you may code separately for some non-Medicare carriers. If the same physician provides the "surgical excision" circumcision and the anesthesia, some payers may want you to indicate "anesthesia by surgeon" with modifier 47 (Anesthesia by surgeon) appended to 54160.

-- Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.