Pediatric Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: One of our pediatricians was asked to do a circumcision only for a patient. The patient was numbed, the physician made a dorsal slit and attempted to do the circumcision, but the infant had hypospadias (752.61 ). Our physician spent an hour with this patient in the hospital but was unable to complete the circumcision. How do I bill for this since the circumcision was not completed? Can we use 99356?

Kentucky Subscriber

Answer: Code 99356 (prolonged physician service in the inpatient setting) is normally used for a chronically ill patient who needs unusual services for high-risk problems. Although this case is certainly unusual in the service provided, it is not an appropriate use for 99356.

You can charge for a dorsal slit only using code 54000 (slitting of prepuce, dorsal or lateral [separate procedure]; newborn) for the procedure actually performed. If your provider decides to use 54000, send a copy of the operative report to substantiate the use of the code. You also might consider using a hospital consultation code 99252 for the visit and again send documentation with the billing.