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E&M with Minor Procedure .

Teresa Posted Mon 11th of November, 2019 07:19:21 AM
If a NEW patient appointment is scheduled FOR THE PURPOSE OF ROUTINE CIRCUMCISION, and the evaluation and management note states in the HPI ; 2 month old male patient whose family desires circumcision. He was not circumcised at birth due to being born premature. OR another example: 4 week old male patient whose family desires circumcision. He was not circumcised at birth due to scheduling. Can you bill a E&M code along with the circumcision code AT THE SAME ENCOUNTER? 99202-25 54150 dx; Z41.2. OR 99203-25 54150 dx: N47.1 -N47.1 is a diagnosis for phimosis. "Phimosis is normal for the uncircumcised infant/child ". Is it acceptable to use N47.1 for a routine circumcision diagnosis?
SuperCoder Answered Tue 12th of November, 2019 03:51:16 AM

Hi Teresa,


Thank you for your question.


When the parent brings the baby (4 week old) in specifically for the circumcision, we will bill only that procedure (CPT 54160) on that day with diagnosis code Z41.2. Hope it helps.


Note: Circumcision has a 10-day global, which could make billing for other services within that period difficult.

Teresa Posted Tue 12th of November, 2019 06:45:22 AM
CPT 54150 "Circumcision, using clamp or other device with regional dorsal penile or ring block". This is the code for Plastibell and has a 0-day global. If the patient new, is it acceptable to bill a new patient visit along with CPT 54150?
SuperCoder Answered Wed 13th of November, 2019 06:46:23 AM
Hi Teresa When a pediatrician performs a circumcision such as Circumcision using clamp or other device newborn and provides a subsequent hospital visit Subsequent hospital care for the evaluation and management of a normal newborn per day or discharge service - Hospital discharge day management many carriers reject the visit...
Teresa Posted Fri 15th of November, 2019 05:45:42 AM
Thank you. I was actually inquiring about a circumcision that is done in the office. If the patient is NEW to the practice, Is it okay to bill an E&M or is it considered included in the work for the 54150?
SuperCoder Answered Mon 18th of November, 2019 07:44:16 AM
nbsp Hi Teresa Private-payer bundling of newborn circumcisions with E M visits has caused decreased reimbursements for many pediatricians Generally insurance companies will not pay for a newborn circumcision in addition to a hospital visit They will reimburse only for one code and deny the higher-paying code the circumcision nbsp...

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