Pediatric Coding Alert

Question: Should I code a ring block the same as a dorsal penile nerve block?

New Jersey Subscriber  
Answer: A ring block is a subcutaneous injection of Xylocaine in four spots around the base of the penis to anesthetize it. A dorsal penile block is two injections. Any local infiltration of Xylocaine "blocks" a nerve. Some physicians consider the ring block superior, while others consider the dorsal block superior because it is only two sticks instead of four.
 
A dorsal penile nerve block performed with a circumcision is coded 64450* (Injection, anesthetic agent; other peripheral nerve or branch). You can bill 64450* with 54150 (Circumcision, using clamp or other device; newborn) or 54160 (Circumcision, surgical excision other than clamp, device or dorsal slit; newborn). If performed during a subsequent hospital visit, bill the hospital visit code (99238, Hospital discharge day management; 30 minutes or less; or 99433, Subsequent hospital care, for the E/M of a normal newborn, per day) with modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) appended.
 
Some pediatric groups have been paid for the nerve block by appending modifier -51 (Multiple procedures) to 64450*. This usually means you will be paid 50 percent of the full fee for 64450*. In any event, you should fight the managed care companies that claim the nerve block is bundled with the circumcision.
  Answers to You Be the Coder and Reader Questions contributed by Richard H. Tuck, MD, FAAP, founding chairman and member, AAP coding and reimbursement committee, practicing pediatrician, Primecare Pediatrics, Zanesville, Ohio; and Thomas Kent, CMM, CPC, president, Kent Medical Management, Dunkirk, Md.