Wiki 54235 vs 54200

[Chelschambers]

I have a physician that is injecting lidocaine into the patient before he performs a 54200. He is wanting to bill 54235 as well. He states "I am not simply doing a subQ lidocaine injection for a local anesthetic – this is a much deeper and more involved injection that does involve the corpora cavernosa." Can he bill the 54235 even though its Lidocaine and not a drug to cause an erection.

 

[CodingKing]

The code is for injection of a vasodilator not a penile block which is bundled into the 54200

 

[emcee101]

He's just doing anesthesia, it doesn't matter how deep he goes into the penis, it is still just anesthesia, which is bundled into the procedure. This would definitely be called "abuse" or upcoding if noticed by an insurance company.

 

[Chelschambers]

Thank you for the feed back. I did not think he could do this, but I wanted more feedback before approaching him.