Urology Coding Alert

Question: What’s the CPT^® code for an in-office visit for a newborn patient that requires cauterization to stop bleeding following his circumcision? The physician’s initial attempt at using a silver nitrate stick failed and was followed up by a successful cauterization using a cautery pen. May I code for the failed first attempt?

Mississippi Subscriber

Answer: If the surgeon was able to successfully chemically cauterize the bleeding area of the penis using the silver nitrate stick, the code for the encounter would meet the criteria for code 17250 (Chemical cauterization of granulation tissue (ie, proud flesh)). Furthermore, you should also keep in mind that CPT^® Assistant (December 2012; Volume 22: Issue 12) explains that you may code separately for nonselective mechanical debridement of the wound bed alongside chemical cautery of hypergranular tissue when performed at the same encounter. As you can see in this example, the physician did not perform a debridement nor was the chemical cauterization successful in controlling the bleeding.

Since the physician had to resort to performing a traditional cauterization to stop the bleeding, you should refer to the Urology Coding Alert, Vol. 22, No. 10 article titled “Get Details on This Lesser Known Sequential Procedures Guideline” for a full explanation as to why you should only report the procedure that “successfully accomplishes the expected result,” accord to the National Correct Coding Initiative (NCCI) Correspondence Language Manual for Medicare Services.

When digging further into the CPT^® code book, you won’t find a CPT^® code that perfectly aligns with this service. For instance, you would not report 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less) since this involves physician work to close a superficial wound. Instead, the only appropriate course of action is to include the cauterization in the evaluation and management (E/M) visit.

Furthermore, since a neonatal circumcision, 54150 (Circumcision, using clamp or other device with regional dorsal penile or ring block), has a 0-day global period, the postoperative E/M office visit is separately billable. However, keep in mind how the coding dynamics might change following the implementation of E/M rules for calendar year (CY) 2021.