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Penile block with 54161

  1. Default Penile block with 54161
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    Can You bill for a penile block 64450 when a circumcision 54161 is performed?
    I believe that the block is included but our physician disagrees.

    Thank You,

    Sherri Sadlocha

  2. #2
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    is that the only anesthesia that was used? Did your doc perform the block himself?

  3. #3
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    Sherri,
    Per CCI Edits the two codes can be billed together - you'd need to put a .59 modifier on the 64450 though.

    Donna
    Donna, CPC, CPC-H

  4. #4
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    actually, I dont need the answers to those questions I previously posed (I was contemplating the use of the 47 modifier)

    You should use 54150 since it includes the penile block If you use 54161 and 64450 that would be unbundling.
    Last edited by mbort; 11-12-2008 at 01:57 PM.

  5. #5
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    54150 & 54161 are quite different procedures. Done very differently. as far as bleeding is controlled vrs clamp ...among other things. But if in reality the provider did a 54161 (on a patient older than 28 days), the answer to your original question is yes - per CCI edits, 54161 and 64450 can be billed together. Modified accordingly, of course

    also, a local anesthetic injection is different than a nerve block
    Donna, CPC, CPC-H

  6. #6
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    Donna is correct..the 54161 and 54150 are totally different techniques.

    IF the 54150 does not work for your particular scenario and the 54161 IS more appropriate, you may want to entertain using the 54161 w/47 modifier. According to Medicare Version CCI Edits 14.3 through Encoder Pro, 64450 DOES bundle (see below) with the 54161 and in "my opinion" does and would not qualify for the -59 modifier.

    In my opinion, the 47 modifier on the actual procedure code (IF your surgeon truly performed the block) is the more appropriate modifier to allow for additional reimbursement of the block.

    from Encoder:
    CCI Unbundles - 54161
    Selected Medicare CCI Version: 14.3
    Download National Correct Coding policy narratives now.

    Warning! These codes may not be billed together. Check to see if a modifier is allowed and supported by documentation.
    Last edited by mbort; 11-12-2008 at 03:30 PM.

  7. #7
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    I would not bill the 64450 for either one; per CCI is included.
    NoRaX

  8. #8
    Default Penile Block w/ 54161
    I agree with the CCI edit for 3rd quarter / append -59


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