Wiki Circumcision CPT?

[valerieeanderson]

I am getting conflicting info and lots of push back from my practice admin as to which circ code is the most appropriate.
Dr performed a circ in office to an adult using a dorsal and ring block, dorsal slit and bell device. I thought it would be54150. Doc chose 54161 and practice admin says this is correct because the insurance states 54150 is for neonates. I looked at CPT Assistant and that states this changed in 2007 to remove the age requirement but if you look in the index it does say neonate. So I don't know which would be appropriate. The patient is self pay. Here's the provider documentation:

Any help is appreciated, I'm just confused....

 

[Jessim929]

We use 54161 for every male over 28 days old - 54150 rejects if they're 29 days old. (we have a Peds doc who sees them that young)

 

[thomas7331]

I am getting conflicting info and lots of push back from my practice admin as to which circ code is the most appropriate.
Dr performed a circ in office to an adult using a dorsal and ring block, dorsal slit and bell device. I thought it would be54150. Doc chose 54161 and practice admin says this is correct because the insurance states 54150 is for neonates. I looked at CPT Assistant and that states this changed in 2007 to remove the age requirement but if you look in the index it does say neonate. So I don't know which would be appropriate. The patient is self pay. Here's the provider documentation:
View attachment 5508
Any help is appreciated, I'm just confused....

I agree with your coding - 54150 is for circumcision with clamp, which is the same as the bell device used here. There is no age limitation to this code.

CPT codes 54160 (28 days or younger) and 54161 (older than 28 days) are the codes split by age, but these are for coding circumcisions using other methods.

 

[liqgold2@aol.com]

It is probably best to check with the insurance carrier first. As 54150 code description per CPT manual does not contain the word neonatal, this code may be used for an infant as well as an adult. Unfortunately, the carrier may not see it this way and is following a deleted rule.