Pediatric Coding Alert

Question: Our pediatrician has never performed a circumcision in the office before, but yesterday he did so for the first time. How should we code this?

Answer: For circumcisions performed in the office on a newborn, you should bill 54150 (Circumcision, using clamp or other device with regional dorsal penile or ring block). You should report any additional and separate evaluation and management work with an office visit code appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service). If the child is over 28 days of age, use the code 54161 (Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age).

Example: Suppose a nine-day-old child who lost weight in the hospital is brought in three days after discharge for a weight check, examination and circumcision. For the examination, you should assign 99213-25 linked to diagnosis code R63.4 (Abnormal weight loss). For the circumcision, report 54150 with a diagnosis of Z41.2 (Encounter for routine and ritual male circumcision).

If you perform the circumcision on a patient older than 28 days, report 54161 (…older than 28 days of age) instead.