New codes for 2007: What you need to know

MS. KNOPF is editor at the Pediatric Coder's Pink Sheet. Reprinted from November 2006 Pediatric Coder's Pink Sheet, copyright (c) 2006 DecisionHealth. For more information on the Pediatric Coder's Pink Sheet, call 1-877-602-3835, or visit the Web site at http://www.decisionhealth.com/index2.aspx?prod_id=361&cat_id=4/.

The author has nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in any part of this article.

CPT 2007 revises circumcision codes to include penile nerve block

Code 54150 is now to be used for circumcision by clamp or dorsal slit "with regional dorsal penile or ring block."

If you perform a circumcision by this method but do not use a block, CPT now directs you to bill 54150 with modifier 52 appended.

Wording and definition changes

The word "newborn" has been deleted from 54150. Code 54152, for a circumcision by clamp or dorsal slit for patients older than 28 days, has been completely deleted. This change in definition tells payers that the numbing injection that keeps babies from feeling the pain of circumcision is included in the procedure.

In the past, you would have billed the block separately with 64450. In most cases the charge was denied because payers interpreted the block as "infiltration" and included it in the surgical package. Now, however, the block is included in the descriptor for 54150 itself, removing all questions about whether you should bill separately.

Don't expect to get paid more, however. While the code definition now formally includes mention of the block, experts don't anticipate your reimbursement to go up as a reflection of the added work. That's because Medicare, in its 2007 physician fee schedule (released November 1), included only a minor modification to the relative value units (RVUs), used to calculate reimbursement. Private payers who follow the fee schedule won't add anything either.

By including the block in the code, CPT has in one fell swoop codified the practice of providing the block-a good thing-but also prevented pediatricians from billing separately for it-not such a good thing. You can only hope that private payers will pay extra now that the definition includes the block.

Fee schedules

The Medicare fee schedule assigned 2.81 RVUs-compared to 2.67 last year-to 54150. Because of the reduced conversion factor for 2007, however, the Medicare fee schedule still gives this code the same amount: about $100.

Surgical excision: For a circumcision done by surgical excision (other than clamp or dorsal slit), use code 54160 or 54161. These two surgical excision codes have been clarified to indicate that 54160 is for a newborn 28 days of age or younger and 54161 is for a male older than 28 days of age. Neither of the surgical excision codes mentions a nerve block. Code 54160 pays about $150, and 54161 pays $207, according to the fee schedule.

Note: Remember that private payers will generally pay more than Medicare, depending on the terms of your contracts.

Global days: There's a zero-day global for 54150, and a 10-day global for 54160 and 54161. Again, whether private payers follow the globals set by Medicare is anyone's guess. If they do, this means that you will be able to bill for any follow-up services for 54150, even if you provide them the next day. For 54160 and 54161, all follow-up care is included for the 10 days following the surgery.