Trueladi33
New
Hi All- I am new to pediatric urology billing and need help understanding this encounter. The provider is billing 99244 with modifier -25 , the patient was referred to him for a consultation for the evaluation of nb circumcision. He performed the circumcision in the same consult visit. He also added a modifier 25 with no other procedure codes listed on the claim. I don't think this is correct based on the CPT descriptor of 99244 and what consultation guidelines is stating. I'm not sure if an E/M office visit is more appropriate with the circumcision procedure added or if this should just be a circumcision procedure visit only. Any advice would be greatly appreciated. Thanks
3wk.o. male seen today in consultation at the request of ZZ Pediatric Center for the evaluation of newborn circumcision.
Np- nb circ/penis with wandering raphe
This has been present since birth. No pain associated with condition and no signs of infection. Patient is voiding and stooling regularly. No family history of urologic conditions. Child is otherwise healthy. No PMH or surgical history.
Impression:
Phimosis (primary encounter diagnosis)
Need for prophylaxis against sexually transmitted diseases
NEWBORN CIRCUMCISION:
- Discussed phimosis in the newborn, and that many times it resolves over time. I talked about etiologies of persistent phimosis. We talked about the relationship between diabetes, the uncircumcised penis, paraphimosis, and phimosis. We talked about the relationship between phimosis, balanitis, and voiding symptoms including urinary retention, pain and irritative voiding symptoms like urgency, frequency, dysuria and others.
- We talked about to various topical creams used to treat phimosis, and the surgery including circumcision. Through a shared decision-making approach, a thorough discussion regarding procedure, risks and benefits of circumcision were reviewed in detail with the parents. I explained the health benefits of circumcision include lower risks of acquiring HIV, genital herpes, HPV and syphilis. Circumcision may also lower the risk of penile cancer the risk of urinary tract infections in the first year of life. The risks, benefits, and some of the possible complications of the procedure were discussed with the patient including bleeding, wound infection, penile adhesions, trapped penis glans hypersensitivity, distal penile shaft scarring, and others. Alternative treatment options were discussed with the patient in detail.
- After all questions were answered, the parents request to proceed with the circumcision based on the preventative health benefits and give consent.
Plan:
Circumcision Procedure Note
Signed informed consent obtained/reviewed.
"Time Out" procedure completed; patient and procedure confirmed.
Infant was restrained in circumcision restraint tray in usual fashion and was provided 24% glucose solution po.
Approximately 3.0 ml of 1% lidocaine w/o epinephrine was infiltrated as a dorsal penile block and also a ring block to provide anesthesia of the distal penis and foreskin.
Foreskin was freed from phimotic adhesions to glans via gentle blunt dissection, foreskin was divided dorsally and then foreskin was removed using 1.3 Gomco circumcision tool.
Vaseline impregnated gauze was applied and the baby tolerated the procedure well.
Blood loss was minimal and estimated to be < 1ml.
Baby tolerated the procedure well.
Family was given instruction sheet and we answered all her questions regarding the postop care.
3wk.o. male seen today in consultation at the request of ZZ Pediatric Center for the evaluation of newborn circumcision.
Np- nb circ/penis with wandering raphe
This has been present since birth. No pain associated with condition and no signs of infection. Patient is voiding and stooling regularly. No family history of urologic conditions. Child is otherwise healthy. No PMH or surgical history.
Impression:
Phimosis (primary encounter diagnosis)
Need for prophylaxis against sexually transmitted diseases
NEWBORN CIRCUMCISION:
- Discussed phimosis in the newborn, and that many times it resolves over time. I talked about etiologies of persistent phimosis. We talked about the relationship between diabetes, the uncircumcised penis, paraphimosis, and phimosis. We talked about the relationship between phimosis, balanitis, and voiding symptoms including urinary retention, pain and irritative voiding symptoms like urgency, frequency, dysuria and others.
- We talked about to various topical creams used to treat phimosis, and the surgery including circumcision. Through a shared decision-making approach, a thorough discussion regarding procedure, risks and benefits of circumcision were reviewed in detail with the parents. I explained the health benefits of circumcision include lower risks of acquiring HIV, genital herpes, HPV and syphilis. Circumcision may also lower the risk of penile cancer the risk of urinary tract infections in the first year of life. The risks, benefits, and some of the possible complications of the procedure were discussed with the patient including bleeding, wound infection, penile adhesions, trapped penis glans hypersensitivity, distal penile shaft scarring, and others. Alternative treatment options were discussed with the patient in detail.
- After all questions were answered, the parents request to proceed with the circumcision based on the preventative health benefits and give consent.
Plan:
Circumcision Procedure Note
Signed informed consent obtained/reviewed.
"Time Out" procedure completed; patient and procedure confirmed.
Infant was restrained in circumcision restraint tray in usual fashion and was provided 24% glucose solution po.
Approximately 3.0 ml of 1% lidocaine w/o epinephrine was infiltrated as a dorsal penile block and also a ring block to provide anesthesia of the distal penis and foreskin.
Foreskin was freed from phimotic adhesions to glans via gentle blunt dissection, foreskin was divided dorsally and then foreskin was removed using 1.3 Gomco circumcision tool.
Vaseline impregnated gauze was applied and the baby tolerated the procedure well.
Blood loss was minimal and estimated to be < 1ml.
Baby tolerated the procedure well.
Family was given instruction sheet and we answered all her questions regarding the postop care.